Q&A: Understanding OIG guidance for outpatient billing policies

Q: How can we ensure our outpatient billing policies meet the Office of Inspector General's (OIG) recommendations?

A: The OIG continues to focus its attention on outpatient services rendered in connection with an inpatient stay. It advises hospitals to adopt the following measures:

• Use computer software to identify any outpatient services that may not be billed separately from an inpatient stay
• Implement a periodic manual review to determine the appropriateness of billing each outpatient service claim (this should be conducted by one or more appropriately trained employees who are familiar with such billing rules)
• Examine any potential bills for outpatient services rendered to a patient at the hospital, within the applicable time period

For more information, see The Compliance Officer’s Handbook, Fourth Edition.