Medicare Compliance Review of Mercy Hospital in Saint Louis for 2011 and 2012

Mercy Hospital in Saint Louis (the Hospital) (operating in Missouri) complied with Medicare billing requirements for 151 of the 205 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 54 claims, resulting in overpayments of $329,000 for calendar years (CYs) 2011 and 2012 (48 claims) and CYs 2010 and 2013 (6 claims). Specifically, 40 inpatient claims had billing errors, resulting in overpayments of $206,000, and 14 outpatient claims had billing errors, resulting in overpayments of $123,000. 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.