OIG: Include more outpatient services in inpatient lump-sum payment

Medicare could reap major savings with an expanded diagnosis related group (DRG) window, which is when outpatient services related to inpatient admissions are included in the inpatient lump-sum payment, according to a new report from the Office of Inspector General. Medicare pays for millions of related outpatient services as separate services, even when those services are provided in settings owned by admitting hospitals or at affiliated hospitals. In fact, the OIG found that in 2011, Medicare and beneficiaries paid about $263 million for 4.3 million related outpatient services provided at settings owned by admitting hospitals in the 11 days prior to the DRG window, as well as roughly $45 million for 777,000 related outpatient services provided at hospitals affiliated with admitting hospitals during the three days prior to inpatient admissions. Report


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