After reviewing 57 claims, the OIG found that Rush University Medical Center incorrectly billed claims which resulted in $10.2 million in overpayments.
This article was originally published on November 30, 2017, on the Association of Clinical Documentation Improvement Specialists.
Rush University Medical Center in Chicago did not comply with Medicare billing requirements for 57 inpatient and outpatient claims reviewed by the HHS Office of Inspector General (OIG), according to the OIG’s November report. According to the report, this resulted in unlawful reimbursement for calendar years 2014 and 2015 with the medical center receiving $814,150 in overpayments, Revenue Cycle Advisor reported.
Out of the 120 claims reviewed by the OIG, 51 inpatient claims and six outpatient claims reportedly have billing errors. The majority of the overpayments were due to inpatient claims errors and were caused by a lack of controls to protect risk areas, according to the report.
Though $792,946 of the overpayments resulted from a failure to meet medical necessity for inpatient rehabilitation care, $19,798 of the overpayments were due to incorrectly assigned DRGs, according to the report.
In total, the OIG says these overpayments add up to an estimated $10.2 million in overpayments per audit period, $814,150 of which were the overpayments identified in the OIG’s sample. The OIG is requesting that Rush University Medical Center refund the total sum to the Medicare contractor, strengthen their controls to be up to date with Medicare compliance requirements, and identify any returned overpayments.
Rush University Medical Center disagrees with the OIG’s findings generally, though they did agree that some of the documentation submitted supported a different level of reimbursement.
Editor’s note: To read Revenue Cycle Advisor’s coverage of this story, click here. To read the full report from the OIG, click here. To read the September/October issue of the CDI Journal focused on denials and audit defense, click here.
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