Medovent Solutions’ Post

In June 2024, the Department of Health and Human Services Office of Inspector General (OIG) released a report describing findings from an OIG audit conducted to assess safeguards in place to detect and prevent improper payments for short inpatient stays and recovering overpayments. The report highlights that although post-payment reviews by BFCC-QIOs included thousands of claims for short inpatient stays and denied $49.2 million in improper payments during the audit period, these reviews denied only 0.6 percent of the $7.8 billion in improper payments estimated by the CMS Comprehensive Error Rate Testing reviews. In part, the response from CMS to the OIG audit included, “CMS will take the OIG’s findings and recommendations into consideration as we determine appropriate next steps.” Utilization management is critical to the success of managing appropriate patient status. Questions to consider for your UM and Revenue Cycle operations: Do you have a comprehensive utilization management structure in place? Does your organization regularly assess potential vulnerabilities regarding short inpatient stay claims? Is a review for medical necessity and provider intervention occurring prior to the admission order? What processes exist to allow for review of short inpatient stays prior to submitting a claim for reimbursement? How do you leverage the expertise of physician advisors in the review process of short inpatient stay cases? Medovent Solutions Advisory Services is here to help! Our subject matter experts can assess your current processes, provide a comprehensive risk assessment identifying gaps compared to best practices, and assist your organization with embedding a framework of quality and process improvement into your utilization management and revenue cycle operations to mitigate risks related to the management of short inpatient stay admissions. Connect with me or Terri Yancey, MSN, ACM-RN, CMAC to learn more and schedule a time to meet! Katie Anderson Charisa Bailey Kelly Lynn John Kiwanuka Clay Grissom Brett Ray