Medicare Compliance Review of Christus Santa Rosa Hospital for the Period January 1, 2010 Through June 30, 2012.

摘要

This review is part of a series of hospital compliance reviews. For calendar year (CY) 2011, Medicare paid hospitals $151 billion, which represents 45 percent of all fee-for-service payments; therefore, the Office of Inspector General must provide continual and adequate oversight of Medicare payments to hospitals. Using computer matching, data mining, and data analysis techniques, we identified hospital claims that are at risk for noncompliance with Medicare billing requirements. For this review, we focused on inpatient stays of 1 day or less (short stays). Our previous work at other hospitals found that a significant proportion of inpatient short stays would more appropriately be billed as outpatient or outpatient with observation services, which generally result in lower reimbursement than inpatient stays. Our objective was to determine whether Christus Santa Rosa Hospital (the Hospital) complied with Medicare requirements for billing inpatient short stays.