Home E-Weekly October 9, 2012

OIG Sets Its Sights on HOPDs

Published: October 8, 2012

The U.S. Department of Health & Human Services' Office of Inspector General is zeroing in on hospital-ASC mergers and the discrepancy between Medicare reimbursement rates in the 2 settings, according to the OIG's 2013 Work Plan.

Here are the specifics of what the OIG will watch closely next year:

  • Hospital acquisitions of ASCs, to determine the impact such transactions have on Medicare payments and beneficiary cost savings. The OIG says it's concerned that hospitals may be acquiring ASCs to secure the higher Medicare rates paid for outpatient services performed in hospital-owned surgical centers.
  • The appropriateness of Medicare's methodology for setting ASC payment rates under the revised payment system established in January 2008, to determine "whether a payment disparity exists between the ASC and hospital outpatient department payment rates for similar surgical procedures provided in both settings."
  • The safety and quality of care provided Medicare patients undergoing surgery in both settings, including before and during procedures, in light of CMS and its stakeholders seeking a comparison of the quality of care provided in ASCs and HOPDs.
  • Physicians' coding of Medicare Part B claims for services performed in ASCs or HOPDs, to ensure the setting is properly coded. Physicians receive different levels of payments based on where they perform procedures.

Representatives from the ASC Association did not respond to requests for comment, and the American Hospital Association could not comment in time for publication.

Click here to receive e-mail alerts from the OIG when reports on these issues are completed and posted.

Daniel Cook

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