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Expansion of the Diagnosis Related Group Payment Window

Issued on  | Posted on  | Report number: A-01-92-00521

Report Materials

EXECUTIVE SUMMARY:

This final audit report provides the results of our review of the diagnosis related group payment window. We estimate that approximately $8.6 million in improper payments for nonphysician outpatient services were made to hospitals under the prospective payment system for the period November 1990 through December 1991. We also identified approximately $4.1 million in improperly charged coinsurance and deductibles related to the improper payments. Our analysis of hospital responses indicated that improper billings were made primarily because of clerical errors and misinterpretation of the regulations. In additional to financial adjustments, we recommended correction of procedural weaknesses.

Report Type
Audit
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
-
Target Groups
-
Financial Groups
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Notice

This report may be subject to section 5274 of the National Defense Authorization Act Fiscal Year 2023, 117 Pub. L. 263.