If your organization received Provider Relief Funds, you might face another audit after a recent Office of Inspector General report.
The PRF terms and conditions included a requirement (referred to as the balance billing requirement) that providers, such as hospitals, must not pursue the collection of out-of-pocket payments from presumptive or actual COVID-19 patients in excess of what the patients otherwise would have been required to pay if the care had been provided by in-network providers.
According to the OIG report, of 25 hospitals reviewed, 17 didn’t meet the requirements around balance billing COVID-19 patients.
What the OIG report found
The OIG looked at patient billings from 25 hospitals that received PRF payments between 2020 and 2023. Of the reviewed hospitals:
- 8 hospitals met the requirement.
- 9 hospitals billed patients improperly, with a total of more than 600,000 dollars in overcharges.
- 13 hospitals billed patients at amounts that may have been noncompliant.
Based on the report, the Health Resources and Services Administration plans to take a closer look at hospital billings during the PRF period and may ask noncompliant hospitals to refund affected patients.
What it means for your healthcare organization
If your organization received Provider Relief Funds payments between 2020 and 2023, your billing practices could be reviewed. Even if you believe your team met the requirements, it’s a good time to double-check your processes.
The OIG has said that inconsistent guidance may have contributed to the confusion, which means some hospitals may not have realized they were out of compliance.
What you can do now
If you received PRF payments, consider:
- Reviewing billing practices for COVID-related out-of-network care.
- Making sure documentation shows how your organization complied with the balance billing rule.
- Preparing for the possibility of an audit by the OIG.
If you have questions, let us know.