Payments for Outpatient Infusion Therapy, Lithotripsy, and Blood Administrations Services Provided at Georgetown University Hospital, Washington, DC.
(10/04/2013)
Pursuant to Title XVIII of the Social Security Act (the Act), the Medicare program provides health insurance for people aged 65 and over and those who are disabled or have permanent kidney disease. The Centers for Medicare & Medicaid Services (CMS) administers the program. Providers generate claims for outpatient services provided to Medicare beneficiaries. CMS guidance requires providers to bill accurately using the appropriate revenue codes and Healthcare Common Procedure Coding System (HCPCS) codes and to report the correct units of service performed. Revenue codes identify the cost center used on the hospitals annual cost report. CMSs outpatient prospective payment...
Tác giả: NTIS |
Số trang: 13 |
Lĩnh vực: Y học lâm sàng |
Năm XB: 2010 |
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Payments for Outpatient Infusion Therapy, Lithotripsy, and Blood Administrations Services Provided at Georgetown University Hospital, Washington, DC. | Số trang: 13
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Pursuant to Title XVIII of the Social Security Act (the Act), the Medicare program provides health insurance for people aged 65 and over and those who are disabled or have permanent kidney disease. The Centers for Medicare & Medicaid Services (CMS) administers the program. Providers generate claims for outpatient services provided to Medicare beneficiaries. CMS guidance requires providers to bill accurately using the appropriate revenue codes and Healthcare Common Procedure Coding System (HCPCS) codes and to report the correct units of service performed. Revenue codes identify the cost center used on the hospitals annual cost report. CMSs outpatient prospective payment system uses the HCPCS code to identify and group services into an ambulatory payment classification group. Medicare fiscal intermediaries use CMSs outpatient prospective payment system to pay for outpatient hospital services on a rate-per-service basis using the ambulatory payment classification group assigned to each service. Generally, when providers bill for more than one surgical procedure on the same date of service, the system pays the first procedure at the maximum allowable payment and additional procedures at half the maximum allowable payment. The George Washington University Hospital (the hospital) is a 371-bed acute-care hospital located in the District of Columbia. During our audit period, Mutual of Omaha was the Medicare intermediary for the hospital. In 2005, Wisconsin Physicians Service Insurance Corporation became the hospitals intermediary. As the current intermediary for the hospital, Wisconsin Physicians is responsible for collecting overpayments for the hospitals claims. Our objective was to determine whether payments received by the hospital from its intermediary were appropriate for
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