Review of Outpatient Claims Processed by Noridian Administrative Services That Included Procedures for the Insertion of Multiple Units of the Same Type of Medical Device in Calendar Years 2008 and 2009

摘要

Common medical devices implanted during outpatient procedures include cardiac devices and joint replacement devices. Generally, a provider implants only one cardiac device during an outpatient surgical procedure. Under the OPPS, payments to hospitals for medical devices are packaged into the payments for the procedures to insert devices. Hospitals are required to report the number of device units and related charges accurately on their claims. The failure to report device units and related charges accurately could result in incorrect outlier payments. Our audit covered $99,947 in Medicare outlier payments to hospitals for 28 claims for outpatient procedures that included the insertion of more than one of the same type of medical device. The 28 claims had dates of service during calendar years (CY) 2008 and 2009. Our objective was to determine whether Medicare paid hospitals correctly for outpatient claims processed by Noridian that included procedures for the insertion of multiple units of the same type of medical device.