Medicare Compliance Review of Mercy Medical Center in Mason City for Calendar Years 2010 and 2011

Mercy Medical Center in Mason City (the Hospital) (operating in Iowa) complied with Medicare billing requirements for 98 of the 145 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 47 claims, resulting in overpayments of $224,000 for calendar years (CYs) 2010 and 2011 (38 claims) and CY 2009 (9 claims). Specifically, 26 inpatient claims had billing errors, resulting in overpayments of $165,000, and 21 outpatient claims had billing errors, resulting in overpayments of $59,000. These errors occurred primarily because the Hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors.