Recovery audit: Boston hospital accepted $1.5 million in Medicare overpayments

Boston-based Brigham and Women's Hospital received $1.5 million in Medicare overpayments thanks to confusion over billing requirements for inpatient and outpatient claims, according to a recovery audit conducted earlier this month, Healthcare Finance News reports.

A total of 219 claims from 2008 through 2010 were found to include errors – specifically, 193 inpatient claims and 26 outpatient claims.

"These overpayments occurred primarily because the hospital did not have adequate controls to prevent incorrect billing of Medicare claims or did not fully understand the Medicare billing requirements," the report said, as quoted by the news source.

In light of the findings – which Brigham and Women's generally agreed with, excepting five inpatient short stay claims – the Office of the Inspector General recommended that the hospital strengthen its controls to ensure compliance.

This month also saw changes to the recovery audit contractor (RAC) program. Per a Centers for Medicare & Medicaid Services announcement, RACs were authorized to request double the number of residential medical records previously allowed as of March 15.

The news source notes in a separate article that before the new rule went into effect, the annual limit for most providers was 1 percent of all claims submitted in the prior calendar year divided by eight. 

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