Medicare contractor makes inappropriate payments
Healthcare Auditing Weekly, January 23, 2007
Associated Hospital Service (AHS), a Medicare contractor based in Maine, made inaccurate payments for claims, a recent OIG audit found.
AHS made full diagnosis-related group payments for claims that should have been reduced to short-stay outlier payments. The claims also should have been reduced by the beneficiaries' co-insurance amounts for lifetime reserve days, according to the audit.
AHS made overpayments totaling more than $936,000 for 83 claims to eight long-term care hospitals in Massachusetts. The services covered were performed between January 1, 2003 and April 30, 2004. This happened because the intermediary did not ensure that the hospitals' claims contained the appropriate coverage status codes.
As part of the OIG's recommendation to resolve the inaccuracies, AHS agreed to recover the overpayments made to the eight hospitals.
Click here to read the complete OIG audit.
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