Reimbursement by Massachusetts Blue Cross for Laboratory Services Performed by Hospitals as an Outpatient Service

EXECUTIVE SUMMARY:

This final audit report points out that in 1991 the Massachusetts Blue Cross (FI) overpaid hospitals $2.25 million in claims for chemistry and hematology tests. The FI's payment process did not detect claims for chemistry tests that should have been grouped together for payment purposes. Also, the FI's system was not able to detect and prevent payment of duplicate claims for chemistry and hematology tests. We recommended that the FI install edits to detect and prevent overpayments for unbundled or duplicate charges for chemistry and hematology tests performed by hospitals on an outpatient basis, and initiate recovery from hospitals for overpayments identified by our review.

---