Review of Medicare Secondary Payer Processes at Maimonides Medical Center for Claims Paid between July 1, 2001 and March 31, 2002

EXECUTIVE SUMMARY:

The objectives of this review was to assess Maimonides Medical Center's (Maimonides) processes and controls for the Medicare Secondary Payer (MSP) provision.  The results indicate that the MSP processes, procedures and controls were generally adequate, but that Maimonides did not always identify the appropriate primary payer.  As a result, the Medicare program was overcharged on behalf of three of the 40 beneficiaries in our review in the amount of $2,154, a private insurer was overcharged for one beneficiary in the amount of $10,000 and Maimonides had not collected $161 from other insurers for services rendered to two beneficiaries.  We also determined that Maimonides underreported credit balances to Centers for Medicare and Medicaid Services in the amount of $2,154.  We recommended that Maimonides review its written policies on MSP questionnaires, provide additional training and supervision for its registrars, ensure that the Medicare program is reimbursed for the improper payments, resubmit claims to collect monies due from private insurers and Medicaid and ensure that pending adjustments are included in its credit balance reports.  Maimonides concurred with the recommendations.