OIG details top unimplemented recommendations for Medicare Parts A and B

The Office of Inspector General (OIG) recently released its annual report on solutions to reduce fraud, waste, and abuse in HHS programs. In the OIG’s 2022 report, 16 of the top 25 unimplemented recommendations involve CMS, with three relating to Medicare Parts A and B.

If implemented, these recommendations would be beneficial “in terms of cost savings, program effectiveness and efficiency, and public health and safety,” said the report. The information in the report was derived from audits and reports issued through December 31, 2021.

Following are the OIG’s recommendations to CMS on Parts A and B:

• Take the necessary steps to establish an inpatient rehabilitation facility (IRF) transfer payment policy for early discharges to home health care and reevaluate the IRF payment system, which could include seeking legislative authority to make changes to more closely align IRF payment rates and costs
• Seek legislative authority to comprehensively reform the hospital wage index system
• Recover overpayments of $1 billion resulting from incorrectly assigning severe malnutrition diagnosis codes to inpatient hospital claims, ensure that hospitals bill appropriately moving forward, and conduct targeted reviews of claims at the highest severity level that are vulnerable to upcoding

According to the 2022 Medicare Trustees Report, the trust fund for Part A will be depleted by 2028, and cost growth for Part B will average 10.5% over the next five years. The OIG referenced these estimates to emphasize the need for implementing these recommendations.

“To ensure that Medicare effectively serves beneficiaries well into the future, HHS must foster sound financial stewardship, program integrity, and improved quality of care and health outcomes,” said the report.

In addition to its recommendations on Parts A and B, the OIG detailed 13 CMS considerations on patient protection, Medicare Parts C and D, and Medicaid. The OIG also included three recommendations given to HHS as a whole.

Revenue integrity professionals should stay up-to-date on IRF transfer payment policy and ensure coding and billing for malnutrition in compliant. Prepare and schedule education where necessary.

Editor’s note: Find more NAHRI coverage of OIG audits and reports here.