Outpatient Services Payment: Beneficiaries Who Are Inpatients of Other Facilities
In a recent report, the Office of the Inspector General (OIG) determined that Medicare inappropriately paid acute-care hospitals for outpatient services provided to beneficiaries who were inpatients of other facilities, including long term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, and critical access hospitals. As a result, beneficiaries were unnecessarily charged outpatient deductibles and coinsurance payments.
All items and non-physician services provided during a Medicare Part A inpatient stay must be provided directly by the inpatient hospital or under arrangements with the inpatient hospital and another provider.
Use the following resources to bill correctly:
- Medicare Does Not Pay Acute-Care Hospitals for Outpatient Services They Provide to Beneficiaries in a Covered Part A Inpatient Stay at Other Facilities MLN Matters Special Edition Article
- Provider Compliance Tips for Ordering Hospital Outpatient Services Fact Sheet
- Acute Care Hospital Inpatient Prospective Payment System Fact Sheet; see payment information on page 3
- Items and Services Not Covered Under Medicare Booklet, Page 12
- Medicare Claims Processing Manual, Chapter 3, Section 10.4
- Medicare Inappropriately Paid Acute-Care Hospitals for Outpatient Services They Provided To Beneficiaries Who Were Inpatients of Other Facilities OIG Report
- CMS MLN Connects dated October 3, 2019
Last Updated Oct 04, 2019