CHA News Article

OIG Reports on Outlier Payment Reconciliation

California hospitals may be among hospitals nationwide with outstanding outlier payments under the Medicare inpatient prospective payment system. The Office of Inspector General (OIG) has released a report that found, contrary to federal regulations and guidance, the Centers for Medicare & Medicaid Services (CMS) did not reconcile outlier payments and, as a result, did not reach settlements with 292 cost reports. OIG recommends that CMS reconcile payments and perform final settlements on the 292 cost reports; ensure Medicare contractors reconcile outlier payments on all cost reports in accordance with federal regulations and guidance; implement an automated system that will recalculate outlier claims; and work with Medicare contractors to develop and maintain a complete and accurate list of cost reports with outlier payments requiring reconciliation. CMS is expected to begin working with its contractors to finalize settlements and recoup payments from hospitals in the near future. The report is available at