The responsibility for measuring and preventing improper payments to acute inpatient prospective payment (IPPS) hospitals and long term care hospitals (LTCHs) has been transferred from quality improvement organizations (QIOs) to fiscal intermediaries (FIs), Medicare administrative contractors (MACs), and Comprehensive Error Rate Testing (CERT) contractors.
CERT contractors began reviewing claims to measure error rates for acute IPPS hospital and LTCH claims on April 1, 2008. FIs and MACs will begin reviewing acute IPPS hospital and LTCH claims, for the purpose of determining the appropriate payment due and preventing or reducing improper payments, this summer.
FIs and MACs will perform medical review of acute IPPS hospitals and LTCH claims, on either a prepayment or post-payment basis to ensure that the services provided are covered, correctly coded and reasonable and necessary services. Claim adjustments will be made as necessary. Additionally, FIs and MACs will conduct provider feedback, through their medical review departments, based on findings from medical review of acute IPPS hospital and LTCH claims.
Source: CMS Fact Sheet, July 9, 2008.
For more information on this and related topics, consult the CCH® Medicare and Medicaid Guide.
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