Review of High-Dollar Payments for Medicare Part A Claims Processed by Pinnacle Business Solutions, Inc., for the Period January 1, 2003, Through December 31, 2003

The objective of this review was to determine whether Pinnacle Business Solutions, Inc.'s (Pinnacle) high-dollar Medicare payments to Arkansas Part A providers for inpatient and outpatient services were appropriate.  Of the eight high-dollar inpatient payments and one high-dollar outpatient payment that Pinnacle made to providers, one inpatient payment was appropriate.  However, Pinnacle overpaid providers $79,037 for six inpatient claims and $257,862 for one outpatient claim.  We were not able to determine the error amount for one inpatient claim because it had not been adjusted by the end of our fieldwork.  We recommended that Pinnacle ensure that the $336,899 in overpayments have been recovered, follow up with the provider on the one claim that had not been adjusted, use the results of this audit in its provider education activities, and identify and recover any additional overpayments made for high-dollar Part A inpatient claims paid after calendar year 2003.  Pinnacle agreed with the findings and recommendations.