The OIG will also review proper physician coding of place of service on Medicare Part B claims for services performed in ASCs and review cost reports of hospitals claiming provider-based status for outpatient facilities.
Regarding the payment system, the OIG said the following:
Section 626(b) of the MMA requires the Secretary to implement a revised payment system for payment of surgical services furnished in ASCs. We will examine changes to the revised ASC payment system and the rate-setting methodology used to calculate ASC payment rates.
Regarding place-of-service errors, the OIG said the following:
Federal regulations at 42 CFR § 414.32 provide for different levels of payments to physicians depending on where the services are performed. Medicare pays a physician a higher amount when a service is performed in a non-facility setting, such as a physician’s office, than it does when the service is performed in a hospital outpatient department or, with certain exceptions, in an ASC. We will determine whether physicians properly coded the places of service on claims for services provided in ASCs and hospital outpatient departments.
Regarding the review of costs reports of hospitals claiming provide-based status for outpatient facilities (as well as inpatient), the OIG said the following:
Pursuant to 42 CFR § 413.65(d), Medicare may permit hospitals that own and operate multiple provider-based facilities or departments in different sites to operate as a single entity, so long as specific requirements are met. Hospitals that receive this “provider-based status” may receive higher reimbursement when they include the costs of a provider-based entity on their cost reports … Provider-based status for outpatient clinics may increase coinsurance liability for Medicare beneficiaries. We will determine the appropriateness of the provider-based designation and the potential impact on the Medicare program and its beneficiaries of hospitals improperly claiming provider-based status for inpatient and outpatient facilities.
Learn more about the OIG 2011 Work Plan.
