Review of Processing of Medicare Credit Balances at Blue Cross/Blue Shield of Connecticut

EXECUTIVE SUMMARY:

This final report of our audit of procedures used for processing outstanding Medicare credit balances at Blue Cross/Blue Shield of Connecticut (Intermediary) and eight randomly selected Connecticut hospitals showed that improvements are needed to ensure that identified Medicare overpayments are promptly refunded to the Medicare program. Our review of the eight sampled hospitals showed that, as a whole, the hospitals did not always follow established procedures for refunding Medicare overpayments within a reasonable time frame (60 days). We also noted that hospitals had attempted to return overpayments to the Intermediary, but the Intermediary did not always take action to process the adjustments. Moreover, credit balance reviews were not always performed by the Intermediary's provider audit unit during its field audits of hospitals' Medicare cost reports because of other priorities.

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