July 23, 2019
Medicare DMEPOS Improper Inpatient Payments
In a recent report (OIG A-09-17-03035
), the Office of Inspector General (OIG) determined that the Centers for Medicare & Medicaid Services (CMS) improperly paid suppliers for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items provided during inpatient stays. Per the requirements in CMS Internet Only Manual (IOM) Pub 100-4, Chapter 3, Section 10.4, Medicare should not pay a supplier for items furnished to a beneficiary when the beneficiary is still an inpatient. The inpatient facility must supply all items directly or under arrangements between the facility and the supplier.
In response to some of the recommendations in the OIG Report, CMS developed a new “Medicare DMEPOS Improper Inpatient Payments” Medicare Learning Network Fact Sheet is available. Learn about:
- Federal regulations and guidance
- Deliveries before discharge
Additional Resources:
- Medicare Quarterly Provider Compliance Newsletter [Volume 9, Issue 2]
- CMS IOM Pub 100-4, Medicare Claims Processing Manual, Chapter 20, Section 10
- CMS IOM Pub 100-4, Medicare Claims Processing Manual, Chapter 30, Section 130.1
- OIG Report: Medicare Inappropriately Paid Acute-Care Hospitals for Outpatient Services They Provided to Beneficiaries Who Were Inpatients of Other Facilities
- OIG Report: Medicare Improperly Paid Suppliers for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Provided to Beneficiaries During Inpatient Stays (HHS-OIG, Office of Audit Services)
- OIG Report: Medicare Paid New England Providers Twice for Nonphysician Outpatient Services Provided Shortly Before or During Inpatient Stays
- OIG Report: Medicare Continues To Pay Twice for Nonphysician Outpatient Services Provided Shortly Before or During an Inpatient Stay
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