Review of High-Dollar Outpatient Claims Processed by Cahaba Government Benefit Administrators Fiscal Intermediary No. 00011 for the Period January 1, 2004, Through December 31, 2006

摘要

Medicare guidance requires hospitals to claim outpatient services using the appropriate Healthcare Common Procedure Coding System codes and to report units of services as the number of times that a service or procedure was performed. During calendar years (CY) 2004 2006, Cahaba Government Benefit Administrators contractor No. 00011 (Cahaba GBA) was the fiscal intermediary in Iowa and processed 25 outpatient claims with payments of $50,000 or more (high-dollar payments). Our objective was to determine whether Cahaba GBAs high-dollar outpatient payments to Iowa providers were appropriate.