Review of Medicare Transitional Pass-Through Payments Made Under The Hospital Outpatient Prospective Payment System for Drugs, Biologicals, and Medical Devices at Saint Mary's Hospital

EXECUTIVE SUMMARY:

The objective of this review was to determine whether transitional pass-through payments received by Saint Mary's Hospital for drugs, biologicals, and medical devices were reimbursed in accordance with Medicare laws and regulations.  Saint Mary's Hospital located in Richmond, Virginia is part of the Bon Secours Richmond Health System (BSRHS).  The BSRHS processes all billing and reimbursements of pass-through items used by Saint Mary's Hospital.  Based on our review of payments for 100 sampled items, we found, with minor exceptions, that BSRHS complied with Medicare laws and regulations for billing transitional pass-through drugs, biologicals and medical devices.  These minor exceptions had an insignificant effect on the overall Medicare reimbursement. However, to prevent such errors from occurring in the future, we recommended that BSRHS use the results of our audit to stress to its employees the need to use correct data in generating Medicare claims.