Ambulatory surgery centers collected at least $102,879 and as much as $6.6 million in improper Medicare payments between 2006 and 2008 for services provided to patients during Medicare-covered stays in skilled nursing facilities, the Department of Health and Human Services' Office of Inspector General has discovered.
Medicare does not allow direct payment to ASCs for services provided to patients in SNF stays; those ASCs must seek payment from the skilled nursing facility, not CMS. However, when OIG closely examined a sample 100 out of 20,906 payments to ASCs suspected of being improper, all 100 of the payments for services rendered to SNF patients were found to be improper. "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," notes Inspector General Daniel R. Levinson in his report.
Based on this sample review, OIG estimates that Medicare overpayments for services provided by ASCs to patients in Medicare-covered SNF stays totaled at least $6.6 million between 2006 and 2008.
The Centers for Medicare and Medicaid Services says it plans to recover the $102,879 in improper payments uncovered in the OIG review and to further review the remaining 20,806 services suspected of generating improper payments to ASCs.
The investigation comes in the wake of a new billing edit CMS implemented in 2010, which prevents the payment of ASC facility costs associated with patients during Medicare-covered SNF stays. The edits are being applied to claims with dates of service on or after Jan. 1, 2008, that are processed on or after July 6, 2010, to ensure improper ASC claims for SNF patients are rejected.
For more guidance on how to bill for services rendered to patients in Medicare-covered SNF stays, see this article from the Ambulatory Surgery Center Association.
Irene Tsikitas
