tci Medicare Compliance & Reimbursement - 2022 Issue Q1

Industry Notes: Feds Look at Hospitals’ PRF Payments Over Balance Billing Concerns

Hospitals that received CARES Act Provider Relief Fund (PRF) payments were required to follow certain billing rules for COVID-19 patients as part of their funding agreements — but some didn’t and now the feds are looking into that. Lowdown: The HHS Office of Inspector General’s (OIG) new Work Plan item, W-00-22-35878, focuses on the intersection of hospitals’ compliance with the PRF payment rules, patients’ rights, and balance billing. “Under the PRF terms and conditions, hospitals are eligible for PRF distribution payments if they attest to specific requirements, including a requirement that providers, such as hospitals, must...

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