April 23, 2009

Review of Medicare Part A Claims Paid by National Government Services for Interrupted Stays at Inpatient Psychiatric Facilities During Calendar Years 2005 & 2006

The audit conducted by the Department of Health and Human Services Office of the Inspector General (OIG) reviewed how one Medicare contractor enforced the Medicare rule for interrupted stays at psychiatric facilities in 2005 and 2006. The audit was reviewing aspects of the 2005-2006 prospective payment system for inpatient psychiatric facilities. OIG found that the contractor, National Government Services, overpaid facilities because it did not distinguish some readmissions within three days of a discharge. The contractor said its data collection and that of the federal Centers for Medicare and Medicaid Services were not capable of readjusting billing and payments if an admission was discovered to be a readmission.