Followup Review of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Provided by Suppliers During Inpatient Stays

OBJECTIVE

Overlapping claims can happen when an enrollee receives a durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) item during an inpatient stay at an acute-care hospital. In general, 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; Medicare Claims Processing Manual, Chapter 3 § 10.4). Therefore, DMEPOS claims for enrollees who received DMEPOS items during an inpatient stay (excluding admission and discharge dates) in a hospital should not be billed to Medicare Part B, and any Medicare payments made on those claims would be considered overpayments. Prior OIG reviews and investigations have identified this area as at risk for noncompliance with Medicare billing requirements. For this followup audit, we will review Medicare payments to certain types of inpatient hospitals to determine whether claims billed to Part B for certain DMEPOS items provided during inpatient stays were made in accordance with Federal requirements. Additionally, we will review the CMS Common Working File system edits that should deny claims for DMEPOS items furnished during an inpatient stay.

TIMELINE

REPORT PUBLISHED