Review of Outpatient Psychiatric Services at Psychiatric Hospitals for Calendar Year 1998

EXECUTIVE SUMMARY:

This final audit report points out that, for Calendar Year 1998, psychiatric hospitals in the 10 locations reviewed were paid a statistically estimated $57 million for unallowable or unsupported outpatient psychiatric services. The payments were unallowable because the services were not documented in accordance with Medicare requirements and/or were not reasonable and necessary. We recommended that the Health Care Financing Administration (HCFA) require Medicare fiscal intermediaries to initiate recovery of payments for claims found in error and increase post-payment reviews of outpatient psychiatric service claims. We also recommended that HCFA further emphasize its documentation requirements for all types of outpatient psychiatric services through seminars, educational sessions, and newsletters. The HCFA concurred with our recommendations.

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