Improper Hospital Charges for Priority Tests Claimed for Medicare Reimbursement

Gao ID: HRD-83-36 January 13, 1983

GAO is currently reviewing ancillary service utilization to assess the reasonableness and medical necessity of ancillary services claimed for Medicare reimbursement.

GAO found that many hospitals claim "stat" charges for Medicare reimbursement which is not allowed. These charges represent an extra charge for diagnostic tests performed on a priority basis. The Health Care Financing Administration (HCFA) Medicare Provider Reimbursement Manual is silent on the allowability of stat charges. However, the view that they are not allowable is contained in a letter to a consultant to the Blue Cross Association. A ruling on stat charges has been requested because Blue Cross plans were uncertain about how to treat such charges and some were reimbursing hospitals for the charges.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

Director: Michael Zimmerman Team: General Accounting Office: Human Resources Division Phone: (202) 275-6195


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