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January 4, 2018 - Updated May 7, 2018

Affected claims are being adjusted. Refer to the J15 Part A Claims Processing Issues Log for Updates.

Payment for Outpatient Services Provided to Beneficiaries Who Are Inpatients of Other Facilities

This article was previously published in the December 14, 2017, issue of the MLN Connects®External PDF

In a recent report, the Office of the Inspector General (OIG) determined that Medicare inappropriately paid acute-care hospitals for outpatient services provided to beneficiaries who were inpatients of other facilities, including long term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, and critical access hospitals. As a result, beneficiaries were unnecessarily charged outpatient deductibles and coinsurance payments.

All items and non-physician services provided during a Medicare Part A inpatient stay must be provided directly by the inpatient hospital or under arrangements with the inpatient hospital and another provider. Use the following resources to bill correctly:

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