Medicare Compliance Review of Billings Clinic Hospital for 2012 and 2013

Billings Clinic Hospital (the Hospital) (operating in Billings, Montana) complied with Medicare billing requirements for 173 of the 179 outpatient and inpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining six claims, resulting in overpayments of approximately $57,000 for calendar years 2012 and 2013. Specifically, five outpatient claims had billing errors, resulting in overpayments of $52,000, and one inpatient claim had a billing error, resulting in an overpayment of $4,500. These errors occurred primarily because the Hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors.