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首页> 美国政府科技报告 >Medicare Continues to Pay Twice for Nonphysician Outpatient Services Provided Shortly Before or During an Inpatient Stay.
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Medicare Continues to Pay Twice for Nonphysician Outpatient Services Provided Shortly Before or During an Inpatient Stay.

机译：医疗保险继续支付两次非住院医生门诊服务，在住院期间或住院期间提供。

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CMS employs Medicare contractors to process and pay hospital inpatient and outpatient claims. Medicare contractors use the Fiscal Intermediary Standard System (FISS) to process inpatient and outpatient claims submitted by the hospitals in their designated jurisdictions. After being processed through the FISS, and prior to payment, all Medicare contractor claims are sent to CMSs Common Working File (CWF) system for verification, validation, and payment authorization. Both the FISS and CWF systems contain edits to prevent and detect overpayments for nonphysician outpatient services furnished shortly before and during inpatient stays. Once the CWF has processed a claim, it electronically transmits a trailer record to the contractor. The trailer record includes information regarding potential errors on the claim. Our nationwide audit covered 148,302 Medicare Part B nonphysician outpatient services provided within 3 days prior to the date of admission for, on the date of admission for, or during (excluding date of discharge) IPPS stays and valued at $12,015,014 for calendar years (CY) 2008 and 2009. Our objective was to determine whether Medicare payments were correct for nonphysician outpatient services provided within 3 days prior to the date of admission for, on the date of admission for, or during (excluding date of discharge) IPPS stays.

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