Review of Billing Procedures for Medicare Claims Submitted to AdminaStar Federal by Inpatient Psychiatric Facilities During 2005

EXECUTIVE SUMMARY:

Our objective was to determine whether inpatient psychiatric facilities (IPF) properly submitted Medicare claims paid by AdminaStar Federal (AdminaStar) for transition stays. 

IPFs did not always properly submit claims paid by AdminaStar for transition stays in 2005.  Specifically, for 76 of the 100 claims that we sampled (from the population of 638 claims), IPFs incorrectly split the beneficiary's stay by submitting 1 claim under the Tax Equity and Fiscal Responsibility Act of 1982 payment period and a second claim under the prospective payment period, rather than properly submitting 1 claim for the entire inpatient stay.  Based on our sample results, we estimate that AdminaStar overpaid IPFs a total of $2.17 million for incorrectly billed Medicare claims for transition stays in 2005.   

We recommend that AdminaStar (1) make the appropriate adjustments to the sampled claims that resulted in overpayments of $340,858, (2) review our information on the additional 538 claims with potential overpayments estimated at $1.83 million ($2.17 million less $340,858) and work with the IPFs that provided the services to recover any overpayments, and (3) analyze postpayment data from IPF claims submitted after our review to ensure that the claims were billed properly and paid correctly by AdminaStar.  AdminaStar agreed with our findings and recommendations and stated that it was taking appropriate action.

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