Are your outlier charges likely to raise CMS scrutiny?
Federal regulators believe certain hospital charging practices are causing some hospitals to disproportionately benefit from use of cost outliers. Healthcare financial managers should determine if their hospital meets CMS criteria proposed for use in auditing outlier charges. Financial managers at hospitals that meet these criteria should assess their charge levels to ensure that they are consistent with market, ensure all documentation relating to increases is retained, and consult with an attorney about performing a shadow audit of outlier documentation.
Kaufman Borgeest & Ryan, LLP, New York, USA. mdavino@kbrny.com
Margaret
M
Davino
D000368:Aged; D014487:Centers for Medicare and Medicaid Services, U.S.; D005375:Financial Audit; D005377:Financial Management, Hospital / Q000331:legislation & jurisprudence*; D017722:Hospital Charges / Q000331:legislation & jurisprudence; D006801:Humans; D006278:Medicare / Q000331:legislation & jurisprudence; D016311:Outliers, DRG / Q000191:economics*; D011445:Prospective Payment System / Q000331:legislation & jurisprudence*; D014481:United States