Review of Medicaid Outpatient Psychiatric Services Provided by Saint Barnabas Hospital, Fordham-Tremont Community Mental Health Center for Fiscal Years Ended September 30, 1999

The objective of our review was to determine whether psychiatric services rendered on an outpatient basis were billed for and reimbursed in accordance with Medicaid requirements.  Generally, we found that the Hospital received reimbursement for claims that were reasonable, necessary, and adequately supported by medical records.  However, our analysis showed that $1,181 (Federal share $591) of the sampled claims did not meet Medicaid criteria for reimbursement.  Claims found unallowable were for services with insufficient treatment plans or not properly supported by medical record documentation.