Medicare potentially overpays Part B claims by $107M
Healthcare Auditing Weekly, February 19, 2008
Medicare may have spent $107 million more than it should have for Part B claims in 2001 and 2002, according to an OIG audit.
The potential overpayments were made to suppliers of outpatient hospital, laboratory, and radiology services for beneficiaries in Part A-covered skilled nursing facility stays. The overpayments occurred because CMS did not have Common Working File (CWF) edits in place. The potential overpayments dropped to $22 million after the edits were fully implemented in 2003.
The OIG recommended CMS:
- Direct the fiscal intermediaries and carriers to review the $106.9 million in potential overpayments for calendar years (CY) 2001 and 2002 and make appropriate recoveries
- Direct the fiscal intermediaries and carriers to initiate recovery of the estimated $17.9 million in un-recovered overpayments for CY 2003
- Continue to test and refine the CWF edits to ensure they properly identify claims subject to consolidated billing
- Ensure all fiscal intermediaries and carriers have established proper controls to recover overpayments identified by the CWF edits
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