Submitting OIG:
Report Description:
We reviewed CMS's oversight of provider-based billing to ensure that only facilities that met provider-based requirements were receiving higher payments allowed by the provider-based designation. Under Medicare, payments for services performed in provider-based facilities are often more than 50 percent higher than payments for the same services performed in a freestanding facility. This increased cost is borne by both Medicare and its beneficiaries. "Provider based" is a Medicare payment designation established by the Social Security Act that allows facilities owned by and integrated with a hospital to bill Medicare as a hospital outpatient department, resulting in these facilities generally receiving higher payments than freestanding facilities. Provider-based facilities, which may be on or off the main hospital campus, must meet certain requirements (e.g., the facility generally must operate under the same license as the hospital). In addition, under current policy, hospitals may, but are not required to, attest to CMS that their provider-based facilities meet requirements to bill as a hospital outpatient department.
Date Issued:
Wednesday, June 15, 2016
Agency Reviewed / Investigated:
Submitting OIG-Specific Report Number:
OEI-04-12-00380
Component, if applicable:
Centers for Medicare & Medicaid Services
Location(s):
Agency-Wide
Type of Report:
Inspection / Evaluation
Questioned Costs:
$0
Funds for Better Use:
$0
Number of Recommendations:
4
View Document:
Attachment | Size |
---|---|
oei-04-12-00380.pdf | 1.22 MB |
Additional Details Link: