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HRD-83-36 1 (1983-01-13)

handle is hein.gao/gaobabmuq0001 and id is 1 raw text is: /Z044A'7 UNITED STATES GENERAL ACCOUNTING OFFICE ¢ yi , WASHINGTON, D C 20548 HUMAN RESOURCES JAN '1 3 98 DIVISION Carolyne K. Davis, Ph.D. Administrator Health Care Financing Administration Department of Health and Human 120447 Services Dear Dr. Davis Subject Improper Hospital Charges for Priority Tests Claimed for Medicare Reimbursement' (GAO/HRD-83-36) Our oftice in currently reviewing ancillary service utilization in 16 selected hospitals in seven states-- California, Colorado, Florida, Massachusetts, New Hampshire, South Carolina, and Utah. The main purpose of the review is to assess the reasonableness and medical necessity of the ancillary services claimed for Medicare reimbursement. Eight PSROs are participating in our study and are reviewing patient records for a sample of Medicare discharges at each of the hospitals. During the medical review, the PSROs found that many hospitals claimed 'stat charges' for Medicare reimbursement which is not allowed. These charges ('stat' taken from the latin statim, meaning immediately) represent an extra charge for diagnostic tests performed on a priority basis. Stat charges were found at three of four New England hospitals, at both Utah hospitals, and at two of four hospitals in Califor- nia. Our work in Florida and Colorado is not yet completed. Because the principal focus of our study was the reasonable- ness and medical necessity of the services provided, we did not pinpoint the total amount of stat charges involved. At two of the New England hospitals, however, we found that for the 130 cases reviewed, the excess charges above standard charges amounted to $9,262.1 iunder Medicare, charges are used as the basis to apportion costs between Medicare and non-Medicare patients. Conse- quently, the extent to which a hospital may actually be overpaid by Medicare because of the inclusion of stat charges would depend on the hospital billing practices for non- Medicare patients and the relative proportion of such charges between Medicare and non-Medicare patients. (106196)

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