Review of High-Dollar Payments for Medicare Part A Claims Processed by TriSpan Health Services for the Period January 1, 2003, through December 31, 2003

Of the 38 payments of $200,000 or more (high-dollar payments) that TriSpan Health Services (TriSpan) made to providers for calendar year 2003, 18 were appropriate. However, TriSpan incorrectly paid providers for 20 claims. For 17 of the 20 claims, providers submitted revised claims that resulted in net overpayments totaling $155,990. For the remaining three claims, providers agreed that they had submitted incorrect claims and said that they would submit revised claims. TriSpan is a Medicare Part A intermediary serving more than 1,800 Medicare providers in Mississippi, Louisiana, and Missouri.

We recommended that TriSpan (1) ensure that identified overpayments have been recovered, (2) follow up with the providers about the three claims that have not been revised, (3) use the results of this audit in its provider education activities, and (4) consider identifying and recovering any additional overpayments made for high-dollar Part A inpatient claims paid after calendar year 2003. TriSpan agreed with our recommendations.