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Assessing Inpatient Hospital Billing for Medicare Beneficiaries

In 2016, hospitals billed Medicare $114 billion for inpatient hospital stays, accounting for 17 percent of all Medicare payments. The Centers for Medicare & Medicaid Services and the Office of Inspector General have identified problems with upcoding in hospital billing: the practice of mis- or over-coding to increase payment. We will conduct a two-part study to assess inpatient hospital billing. The first part will analyze Medicare claims data to provide landscape information about hospital billing. We will determine how inpatient hospital billing has changed over time and describe how inpatient billing varied among hospitals. We will then use the results of this analysis to target certain hospitals or codes for a medical review to determine the extent to which the hospitals billed incorrect codes.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
November 2018 Centers for Medicare & Medicaid Services Assessing Inpatient Hospital Billing for Medicare Beneficiaries Office of Evaluation and Inspections OEI-02-18-00380 2020

Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201