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Our objective was to determine whether inpatient
psychiatric facilities (IPF) properly submitted Medicare claims paid by
Riverbend Government Benefits Administrator (Riverbend) for transition stays.
IPFs did not always properly submit claims paid by Riverbend for transition stays
in 2005. Specifically, for 82 of the 100 claims that we sampled (from the
population of 184 claims), IPFs incorrectly split the beneficiary’s stay by
submitting 1 claim under the Tax Equity and Fiscal Responsibility Act of 1982
payment period and 1 or more claims under the prospective payment period, rather
than properly submitting 1 claim for the entire inpatient stay. Based on our
sample results, we estimate that Riverbend overpaid IPFs a total of $1,067,157
for incorrectly billed Medicare claims for transition stays in 2005.
We recommended that Riverbend (1) make the appropriate adjustments to the sampled claims that resulted in overpayments of $579,977, (2) review our information on the additional 84 claims with potential overpayments estimated at $487,180 ($1,067,157 less $579,977) and work with the IPFs that provided the services to recover any overpayments, and (3) analyze postpayment data from IPF claims submitted after our review to ensure that the claims were billed properly and paid correctly by Riverbend .
Riverbend agreed with our findings and recommendations and stated that it was taking appropriate action.