Based on a sample review, the OIG estimates Medicare contractors made at least $6.6 million in overpayments to ASCs for services provided to beneficiaries during Part A SNF stays from 2006 through 2008. The OIG found all of the 100 services it reviewed were incorrectly billed to Medicare Part B even though they were also included in the SNFs’ Part A payments. As a result, Medicare paid twice for these services: once to the SNF under the Part A prospective payment system and again to the ASC under Part B.
The OIG recommends CMS instruct its Medicare contractors to do the following:
1. Recover the $103,000 in overpayments for the 100 incorrectly billed services that were identified.
2. Review the 20,806 services that the OIG did not review and recover overpayments estimated to total at least $6.5 million.
3. Provide guidance to ASCs on consolidated billing requirements and the need for timely and accurate communication between ASCs and SNFs regarding beneficiaries’ Medicare Part A status.
4. CMS establish an edit in the Common Working File to prevent Part B payments for ASC services that are subject to consolidated billing.
Read the OIG report on payments for ambulatory surgical center services provided to beneficiaries in skilled nursing facility stays (pdf).
Read more about the OIG:
– State Reps. Stark and Herger Will Re-Introduce Medicare Fraud Bill Next Year
– OIG Outlines $26B in Savings for FY 2010
– OIG: Payment Errors Can Be Reduced by Focusing on “Error-Prone” Providers
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