OIG to Investigate Hospital Payments in 2013

Payment for mechanical ventilation

This project will select Medicare payments to review whether hospitals provided the minimum 96 hours of mechanical ventilation, required for certain DRG payments to qualify.

Quality improvement organizations

The OIG will assess barriers that these CMS-contracted organizations experience when they work with hospitals on quality projects or when they provide technical assistance. "Medicare spends $1.1 billion for each three-year QIO contract period, and each contract calls for QIOs to provide technical assistance to providers and specifies clinical areas for the quality improvement projects."

Provider-based status

The office will examine the "impact" of a practice in which providers, non-hospital owned physician practices, which are not based at a hospital, submit claims to Medicare as if they were provider-based.

"We will also determine the extent to which practices using the provider-based status met CMS billing requirements."  A Medicare Payment Advisory Commission report in 2011" expressed concerns about the financial incentives presented by provider-based status and stated that Medicare should seek to pay similar amounts for similar services."

Acquisition of ambulatory surgical centers

The office also will look into a practice by which hospitals are acquiring ambulatory surgical centers and converting them to hospital outpatient departments, and the impact that has on Medicare payments and beneficiary cost sharing.

"Medicare reimburses outpatient surgical services performed in hospital outpatient departments at a higher rate than similar services performed in ASCs," the work plan says.  "Hospitals may be acquiring ASCs and providing outpatient surgical services in that setting."