OIG targets cardiac caths, two-midnight rule

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Call it an ambitious set of New Year’s resolutions. The Office of the Inspector General (OIG) released its to-do list for 2015, including a look at the financial impact of the two-midnight policy and a nationwide review of cardiac catheterizations and endomyocardial biopsies.

The OIG grouped it its annual work plan under Medicare Part A and B; Medicare Part C and Part D; Medicaid; and other governmental units. The top challenges with Medicare Part A and B for 2015 were reducing waste and improving quality, according to the office. It planned to concentrate on quality and access to care, inefficient payment and policy practices and the shift from volume-based to value-based practices.

It noted that the two-midnight rule criteria “represent a substantial change in the way hospitals bill for inpatient and outpatient stays.” The rule, initiated for fiscal year 2014, instructs physicians to admit Medicare patients who are expected to require at least two nights of hospital care as inpatient and those needing less as outpatient. The review is designed to assess the impact of the change on hospital billing, Medicare reimbursement and patient copayments.

Also under hospital-related policies and practices, the OIG wrote that it would review Medicare claims for additional medical services when medical devices are defective to determine the additional costs. The Centers for Medicare & Medicaid Services has expressed concern about the cost of ancillary and replacement costs for defective devices.

Under billing and payments, the OIG planned to review Medicare outpatient payments to hospitals for evaluation and management services billed as new patient clinic visits to identify overpayments. Patients who had been registered as inpatient or outpatient by the hospital within the past three years are considered established. If they are erroneously categorized as new patients, the OIG will recommend recovery of the overpayment.

Right heart catheterizations procedures also will be scrutinized in 2015, based on previous investigations that found some hospitals received payments for right heart catheterizations procedures “when the services were already included in payments for endomyocardial biopsies.” The nationwide review will look at right heart catheterizations and endomyocardial biopsies billed during the same session.