Review of Medicare Credit Balances at Part B Providers

EXECUTIVE SUMMARY:

The objective of this review was to identify potential Part B credit balances and substantiate their existence through confirmation with the Medicare carriers and the beneficiaries' primary insurers.  Based on our review and confirmation with insurance companies, we found that payments made by Blue Cross and Blue Shield of Rhode Island (BSBSRI) for services for 3 of the 10 sample beneficiary cases included 60 mistaken Part B payments valued at $5,995 that have not been recovered by Medicare.  Of the $5,995 in mistaken payments, $2,357 represented payments for services paid by both Medicare and the primary insurer.  The remaining $3,638 represents improper payments for services that should have been billed to the primary insurer.  We provided BCBSRI with the claims detail information to facilitate its collection efforts with respect to these credit balances.  The BCBSRI has taken overpayment action on the 60 mistaken payments processed by their office.

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