Verification of Saint Francis Medical Center's Refund of Place-of-Service Overpayments for Calendar Years 2009 Through 2010

摘要

The Hospital submits claims for the overhead expenses of medical services performed at the Hospital and bills on behalf of its physicians for their Part B physician services. In addition, two independent physician practices use the same billing service as the Hospital for Part B services performed at the Hospital; we included these practices billing claims in our review of the Hospitals overpayments. As the Medicare contractor for hospital and physicians in Missouri, Wisconsin Physician Services processes and pays the Hospitals claims for Medicare outpatient services and its claims for physician services. The Hospitals officials insisted on refunding all overpayments received resulting from these place-of-service coding errors. The Hospital asked the Office of Inspector General to verify the accuracy of its overpayment calculations so it could refund its Medicare contractor. Our objective was to determine the amount of overpayments for claims with place-of-service coding errors submitted by the Hospital to its Medicare contractor for calendar years (CY) 2009 through 2010.