Understanding the OIG’s Latest Work Plan
Hospital Policies and Practices
The Two-Midnight Rule
The OIG will examine how the two-midnight rule affects hospital billing practices, Medicare payments, and beneficiary payments. The rule provides that physicians should admit beneficiaries for inpatient care if they are expected to need at least two nights of hospital care, and that beneficiaries who are expected to need less than two nights of hospital care should be treated as outpatients.
Billing by Provider-Based and Freestanding Clinics
Hospital Billing and Payment
Indirect Medical Education (IME) Payments
The OIG intends to review hospital data to determine whether hospitals’ IME payments were calculated in accordance with federal regulations and guidelines. Prior OIG reviews have identified hospitals that have received excess reimbursement for IME costs. Hospitals can expect that the OIG will recommend recoupment if it identifies excess reimbursement.
Quality of Care and Safety
Case Study of Hospitals’ Emergency Preparedness and Response
Oversight of How Hospitals Grant Medical Staff Privileges
The OIG will examine how hospitals assess medical staff candidates prior to granting initial privileges, including verifying credentials and reviewing data in the National Practitioner Databank.