Review of Medicare Payments Exceeding Charges by $500 to $1,000 for Outpatient Services Processed by National Government Services But Transitioned to Palmetto GBA, LLC, in Jurisdiction 11 for the Period January 1, 2006 Through June 30, 2009

摘要

On May 21, 2010, CMS announced that Palmetto GBA, LLC (Palmetto), had been awarded the contract as the Medicare administrative contractor for Jurisdiction 11 in four States: North Carolina, South Carolina, Virginia, and West Virginia. For Virginia and West Virginia providers, the effective date for transferring from NGS to Palmetto was May 16, 2011. Because Palmetto has assumed responsibility for claims paid by NGS, we have addressed our findings and recommendations to Palmetto for review and comment. Our objective was to determine whether certain Medicare payments in excess of charges by $500 to $1,000 that NGS made to providers for outpatient services were correct.