Corporate Compliance

Other Issuances: OIG issues reviews of high-dollar claims, CMS updates FAQs

Medicare Insider, April 14, 2009

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OIG reviews high-dollar payments for Medicare outpatient claims processed by TriSpan for the period January 1 through December 31, 2004

On April 9, the OIG released a review of high-dollar payments for Medicare outpatient claims processed in 2004 by TriSpan Health Services, a Medicare fiscal intermediary. Of the 16 payments of $50,000 or more that TriSpan made to providers for outpatient services during 2004, the OIG found that only one was appropriate. TriSpan overpaid two providers $767,000 on 15 claims.

View the OIG report.

OIG reviews of high-dollar payments for inpatient services processed by NGS in certain states for calendar years 2004 through 2006

On April 6, the OIG released a review of high-dollar payments for inpatient services processed from 2004–2006 by National Government Services (NGS), a Medicare fiscal intermediary, in Illinois, Indiana, Kentucky, and Ohio. The OIG found that of the 303 high-dollar payments NGS made to hospitals for inpatient services during these years, 39 were appropriate. The remaining 264 payments included net overpayments totaling $7.4 million.

View the OIG report.

Frequently asked questions

CMS released several new/updated frequently asked (FAQ) questions last week related to Medicare fee-for-service payment.

View the FAQs.



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