CMS investigates outlier payments.
CMS is increasing its scrutiny of hospital billing practices in the wake of excessive claims for outlier payments by some healthcare organizations. Hospitals should review their billing practices to ensure that they are using a charge schedule that complies with Medicare regulations Hospitals also should conduct ongoing reviews of their outlier cases to ensure that their charge structures are appropriate and their outlier services are medically necessary. Hospitals can expect CMS to implement changes to the outlier regulations.
Brock
Thomas H
TH
Proskauer Rose LLP, Washington, D.C., USA. tbrock@proskauer.com
D014487:Centers for Medicare and Medicaid Services, U.S.; D005245:Fee Schedules; D005375:Financial Audit; D005377:Financial Management, Hospital / Q000592:standards*; D005607:Fraud / Q000517:prevention & control; D006801:Humans; D007344:Insurance Claim Reporting / Q000592:standards; D016344:Medicare Part A / Q000592:standards*; D016311:Outliers, DRG / Q000191:economics*; D011445:Prospective Payment System / Q000592:standards*; D014481:United States