• 主题
高级搜索  >
历史搜索 清空历史
首页> 美国政府科技报告 >Payments For Ambulatory Surgical Center Services Provided to Beneficiaries in Skillsed Nursing Facility Stays Covered Under Medicare Part A in Calendar Years 2006 through 2008
【24h】

Payments For Ambulatory Surgical Center Services Provided to Beneficiaries in Skillsed Nursing Facility Stays Covered Under Medicare Part A in Calendar Years 2006 through 2008

机译：针对2006年至2008年日历年医疗保险a部分涵盖的技能护理设施受益人提供的门诊手术中心服务付款

获取原文
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

Section 1888(e) of the Social Security Act (the Act) established a prospective payment system for skilled nursing facilities (SNF). Under the prospective payment system, Medicare pays SNFs for all covered SNF services. Pursuant to the Acts consolidated billing requirements, SNFs are responsible for billing Medicare for virtually all services furnished to SNF residents during a Part A covered stay, regardless of whether SNFs furnish the services directly or under arrangements with outside suppliers. For services furnished under arrangements with outside suppliers, the suppliers are responsible for billing the SNFs (rather than Medicare Part B) Therefore, Medicare Part B payments that suppliers receive for these services are overpayments. Ambulatory surgical center (ASC) facility services, such as nursing, recovery care, anesthetics, drugs, and other supplies, provided to SNF residents are subject to consolidated billing and must be billed to the SNF rather than Medicare Part B. Physicians professional services are statutorily excluded from consolidated billing and may be billed to Medicare Part B. Our nationwide audit covered 20,906 Medicare Part B ASC facility services valued at $7,113,542 with dates of service in calendar years (CY) 2006 through 2008 that matched 14,192 Part A SNF stays and that thus represented potential overpayments. We sampled 100 services provided by 88 ASCs. OBJECTIVE. Our objective was to determine whether ASCs complied with consolidated billing requirements in CYs 2006 through 2008. SUMMARY OF FINDINGS ASCs did not comply with consolidated billing requirements in CYs 2006 through 2008. All 100 services that we reviewed, totaling $102,879, were incorrectly billed to Medicare Part B even though they were included in the SNFs Part A payments. As a result, Medicare paid twice for these services: once to the SNF under the Part A prospective payment system and again to the ASC under Part B. Based on our sample results, we estimated that Medicare contractors made at least $6.6 million in overpayments to ASCs for services provided to beneficiaries in Part A SNF stays in CYs 2006 through 2008. These overpayments occurred because ASCs did not have the necessary controls to prevent incorrect billing to Medicare Part B. In addition, the payment controls in the Centers for Medicare & Medicaid Services (CMS) Common Working File were not designed to prevent and detect Part B overpayments to ASCs for services subject to consolidated billing.

著录项

相似文献

  • 外文文献
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号