Review of Outpatient Surgeries Billed by Hazel Hawkins Memorial Hospital

摘要

For calendar year (CY) 2012, Medicare paid hospitals $148 billion, which represented 43 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 for outpatient surgeries that were at risk for noncompliance with Medicare billing requirements because they were billed with units of service greater than one, indicating that the surgeries may have been performed multiple times. Our objective was to determine whether Hazel Hawkins Memorial Hospital (the Hospital) complied with Medicare requirements for billing outpatient surgeries on selected claims.