Review of Medicare Payments Exceeding Charges for Outpatient Services Processed by Noridian Administrative Services, LLC, in Jurisdiction 6 - Minnesota for the Period January 1, 2006, Through June 30, 2009

摘要

Noridian Administrative Services, LLC (Noridian), has been the fiscal intermediary for the State of Minnesota since August 1999. On January 7, 2009, CMS awarded the Medicare Administrative Contractor contract for Jurisdiction 6, which includes Minnesota; however, protests were filed against the award. CMS is taking corrective action on the award. In the meantime, Noridian, acting as the legacy fiscal intermediary, continues to process claims for providers in Minnesota. During our audit period (January 2006 through June 2009), approximately 46.9 million line items for outpatient services were processed for Minnesota, of which 520 line items had (1) a Medicare line payment amount that exceeded the line billed charge amount by at least $1,000 and (2) 3 or more units of service. (A single Medicare claim from a provider typically includes more than one line item. In this audit, we did not review entire claims; rather, we reviewed specific line items within the claims that met these two criteria. Because the terms payments and charges are generally applied to claims, we will use line payment amounts and line billed charges.) Our objective was to determine whether certain Medicare payments in excess of charges that Noridian made to providers for outpatient services were correct.