Review of Hospital Medicare Secondary Payer Issues

EXECUTIVE SUMMARY:

The objective of this review was to determine whether Orange Park Medical Center (the hospital) complied with Medicare Secondary Payer (MSP) regulations regarding both inpatient and outpatient settings during its fiscal year ended June 30, 2000.  We found that, for 64 percent of the claims reviewed, the hospital could not provide sufficient documentation to demonstrate compliance with Medicare guidelines and it's policies and procedures regarding the completion and adequacy of MSP questionnaires.  This condition could lead to Medicare absorbing a share of the costs applicable to other payers and to credit balances being generated and requiring unnecessary administrative expenses to resolve.  In this respect, a review of 25 credit balances showed that in 7 instances Medicare was billed in the wrong order.  In reviewing these credit balances, we also found that the hospital did not always refund Medicare credit balances in a timely fashion.