OIG to Investigate HIX Flaws in 2014
Appropriate Transplant Billing
OIG will seek to identify hospitals that have incorrectly billed separately parts of the process necessary for bone marrow or stem cell transplants, such as harvesting, transplant, chemotherapy and radiotherapy prior to transplant, when those steps are included in the payment, and only for specific diagnoses.
Appropriate Cardiac Services Billing
OIG will investigate whether hospitals inappropriately billed separately for right heart catheterizations and heart biopsies during the same operative session, procedures that are included in the payment for heart biopsies.
Defective Medical Devices
OIG will seek to determine whether Medicare has paid for costs associated with defective medical devices. "CMS has previously expressed concerns about the impact of the cost of replacement devices, including ancillary cost, on Medicare payments for inpatient and outpatient services."
Correct Medical Education Billing
OIG will investigate whether teaching hospitals correctly calculated amounts requested to cover indirect medical education, which use the hospital's ratio of resident full-time equivalents to available beds.
The practice in which hospitals bill Medicare for care to patients with Kwashiorkor, a rare condition usually seen only in areas hit by famine, is not supported by documentation and will be investigated in 2014. "Prior OIG reviews have identified inappropriate payments to hospitals for claims with a Kwashiorkor diagnosis," the work plan states.
Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
- EHR Systems 'Immature, Costly,' AMA Says
- Better HCAHPS Scores Protect Revenue
- Anthem Blue Cross, 7 CA Health Systems Create New Challenger, Business Model
- Interstate Medical Licensure Effort Advances
- Narrow Networks Cut Costs, Not Quality, Economists Say
- CEO Exchange: Preparing for Population Health
- Data Points to Boom in Private HIX
- How to Build a Health Plan from Scratch
- 'Early Offer' Malpractice Programs May Spur Reform
- Insurers see cost hikes in Partners HealthCare (MA) mergers