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Medicare Payments for Overlapping Part A Inpatient Claims and Part B Claims

Overlapping claims can happen when a beneficiary is an inpatient of one hospital and then sent to another hospital to obtain outpatient services that are not available at the originating hospital. Certain items, supplies, and services furnished to inpatients are covered under Medicare Part A and should not be billed separately to Medicare Part B (42 CFR 409.10 and 410.3; Medicare Claims Processing Manual, Ch. 3 10.4). Durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) claims for beneficiaries who received DMEPOS items while in an inpatient stay in a hospital should not be billed to Medicare separately. The payments associated with these claims are considered overpayments because Medicare does not allow separate payment for DMEPOS when a beneficiary is in a covered inpatient stay (Medicare Claims Processing Manual, Ch. 20 01). We will review the CMS Common Working File (CWF) edits that should deny claims for DMEPOS items furnished during an inpatient stay. Prior OIG reviews and investigations have identified this area as at risk for noncompliance with Medicare billing requirements. We will review Medicare payments to certain types of inpatient hospitals to determine whether claims billed to Part B for certain items, supplies, and services provided during inpatient stays were made in accord with Federal requirements.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
Completed Centers for Medicare & Medicaid Services Medicare Payments for Overlapping Part A Inpatient Claims and Part B Outpatient Claims Office of Audit Services A-09-17-03035;