Review Of Medicare Secondary Payer Processes At Lenox Hill Hospital for Claims Paid Between July 1, 2001 and March 31, 2002

EXECUTIVE SUMMARY:

This audit reviewed Lenox Hill Hospital's (Lenox) processes and controls for the Medicare Secondary Payer (MSP) provision.  Medicare laws, regulations and guidelines specify the conditions under which parties other than the Medicare program have the primary responsibility to pay for health care services.  Our review showed that Lenox's processes, procedures and controls were generally adequate, but that Lenox did not always identify the appropriate primary payer.  As a result, Medicare was overcharged $10,691 on behalf of three beneficiaries.  We also determined that Lenox underreported credit balances to the Centers for Medicare and Medicaid Services in the amount of $13,066.  We recommended that Lenox provide additional training and supervision for its registrars, improve the patient information in the computerized registration system, ensure that the Medicare program is reimbursed for the improper payments and that pending adjustments are included in its credit balance reports, and place greater emphasis on the importance of credit balance reporting.  Lenox concurred with our recommendations.