Review of Medicare Same-Day, Same-Provider Acute Care Readmissions in Pennsylvania During Calendar Year 1998

EXECUTIVE SUMMARY:

The objective of this review was to determine whether Medicare payments made to acute care hospitals in Pennsylvania during Calendar Year 1998 were appropriate for beneficiaries who were discharged and readmitted to the same hospital on the same day.  Our review of same-day, same-provider readmissions found that 63 readmissions totaling $290,744 were billed incorrectly because the beneficiary was either admitted to a non-acute care unit within the hospital or was never actually discharged from the initial admission.  Our review also identified a methodology that involves minimal effort that the Centers for Medicare and Medicaid Services could use to identify same-day, same-provider readmissions that are vulnerable to billing errors nationwide.