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OIG Finds Hospital Overpayments for Transfer to Home Health Services

For directors of reimbursement, HIM professionals

The federal Department of Health and Human Services Office of Inspector General (OIG) has issued a report that concludes that Medicare overpaid acute care hospitals $267 million over a two-year period, due to improper coding of the inpatient claim when the beneficiaries resumed home health (HH) services within three days of discharge.  

The OIG notes that hospitals failed to code the inpatient claim as a discharge to home health services, or incorrectly applied condition code 42 (HH not related to inpatient stay), or 43 (HH not within three days of discharge). Based on these findings, the OIG recommends that the Centers for Medicare & Medicaid Services (CMS) direct its contractors to take steps to recover overpayments, correct related system edits, improve provider education,  and use data analytics to identify hospitals using certain conditions does disproportionately.  

The OIG also recommends that CMS take steps to deem HH services that start within three days of discharge to be related to the inpatient claim, to reduce the need for clinical judgement when processing claims.   

Click here for a summary of the report.