Review of Massachusetts Medicaid Payments For Outpatient Non-Physician Services Rendered From October 1, 1999 Through March 31, 2001 During An Inpatient Stay

EXECUTIVE SUMMARY:

According to the Massachusetts State Plan, hospitals should not be reimbursed for outpatient services rendered during an inpatient stay.  To perform our review, we independently generated a computer match of outpatient non-physician services rendered during an inpatient stay with claim paid dates from October 1, 1999 through March 31, 2001.  Based on the results of this computer match, we reviewed a random sample of 100 and found that only 2 of the 100 services were duplicated.  Accordingly, we concluded that the risk is low that DMA made duplicate payments for outpatient services rendered during an inpatient stay.

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