Payment Matters: OIG Reports Ambulatory Surgical Centers Incorrectly Billed for Skilled Nursing Facility Bundled Services

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The Office of Inspector General (OIG) recently released an audit of ambulatory surgical center (ASC) services provided to skilled nursing facility (SNF) residents that were billed to Medicare Part B and concluded that 100% of the services were billed, and reimbursed, incorrectly. The OIG audited 100 claims for bundled services provided by ASCs from CYs 2006 through 2008 to SNF residents during their Part A covered stays. The OIG concluded that these samples represented overpayments by Medicare Part B of $102,879 to the ASCs.

The OIG concluded that Medicare had paid twice for these services. First, the prospective payment system for SNFs requires that SNFs furnish, and be reimbursed for, almost all services provided to Medicare residents during Part A covered stays. Accordingly, Medicare Part A reimbursed the SNF for these bundled services as part of the SNF resident's covered stay. Medicare Part B paid for these services a second time after each ASC billed Medicare Part B for the services. The OIG concluded that the ASCs should have billed each resident’s SNF, in each case, as part of a bundled service from a covered stay.

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