Colorado Did Not Properly Pay Some Medicare Part B Deductibles and Coinsurance.

摘要

In Colorado, the State agency is responsible for processing crossover claims. Those responsibilities include establishing systems and internal controls, which include policies and procedures to accurately pay Medicare Part B deductibles and coinsurance in accordance with the State plan. To execute the provisions of the State plan for Medicare Part B services, the State agency should compare the Medicare payment to the State Medicaid plan rate for each crossover claim to determine the allowable payment of Medicare Part B deductibles and coinsurance. Based on this comparison, the allowable payment is the lower of (1) the Medicaid-allowed charge minus the Medicare payment or (2) the sum of the Medicare deductible and coinsurance. The State agency claimed Federal reimbursement for Medicaid payments totaling approximately $9.0 billion (approximately $4.8 billion Federal share) during Federal fiscal years (FYs) 2011 and 2012 (October 1, 2010, through September 30, 2012). As part of these Medicaid payments, the State agency claimed approximately $64.3 million (approximately $34.3 million Federal share) for payments for Medicare Part B deductibles and coinsurance.