UPMC incorrectly billed Medicare for same-day readmissions

Following federal recommendations, the University of Pittsburgh Medical Center (UPMC) has refunded $26,547 for overcharging Medicare with incorrectly billed same-day readmissions, reported the Pittsburgh Post-Gazette.

In 2008 and 2009, UPMC Presbyterian-Shadyside improperly billed seven readmissions as separate inpatient stays instead of continuous stays, according to a report from the Office of Inspector General (OIG). For the incorrect claims, the readmission was related to the initial admission's medical condition and should have been billed as one continuous stay.

Medicare paid the hospital $112,977 for those seven claims, when UPMC should only have received $86,430, the report noted.

"These overpayments occurred because Presbyterian Shadyside did not have adequate training to review same-day readmissions and prevent incorrect billings," the OIG said.

Presbyterian Shadyside agreed with the OIG's report and has followed its recommendations to repay the funds and reinforce its review of same-day readmissions.

"The care managers were retrained on how to review these claims, after the initial review by the care management staff, the cases are sent to the physician advisor for final recommendation on the readmission decision," UPMC said in response to the report. "Additionally, we have added periodic monitoring of same day readmissions to our compliance plan to support ongoing compliance."

For more information:
- read the Post-Gazette article
- check out the OIG report (.pdf)

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