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OIG to Investigate HIX Flaws in 2014

Cheryl Clark, for HealthLeaders Media, February 3, 2014

In addition, the OIG is looking at controls to determine the accuracy of eligibility for enrollment and subsidy payments, selection of contractors, contract types, "and the rationale for these selections." There is a separate new project to determine "whether performance-based contracting was used to determine payments to contractors; whether contractors were paid appropriately."

In FY 2013, the work plan says, the OIG's work recovered $5.8 billion in receivables, including findings in amounts paid to states for their share of the Medicaid programs. The OIG also says that it "identified $19.4 billion in savings" because of prior legislative, regulatory or administrative actions identified by its recommendations.

For the 2014 projects of specific interest to hospital leaders, 12 new projects top the OIG's wish list for 2014. They include:

The 2-Midnight Rule
New admission criteria specifying which patients should be assigned to "observation" status versus inpatient stay, which pays a much higher reimbursement. "Previous OIG work found overpayments for short inpatient stays, inconsistent billing practices among hospitals, and financial incentives for billing Medicare inappropriately," the work plan says.

Under the new criteria, physicians may admit patients expected to need at least two nights of hospital care; beneficiaries' whose care is expected to require a shorter stay are treated as outpatients on observation status. The investigation will detail variations in hospital billing practices during the 2014 fiscal year.

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