Medicaid Clinical Laboratory Service Payments, Department of Public Health And Human Services : Limited Scope Review 1997

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Federal guidelines state the fee schedule amount of 62 percent is payable only to a qualified hospital laboratory located in a sole community hospital.
During our testing of clinical laboratory services we reviewed the percentages paid to hospitals. Two hospitals in our sample were paid incorrectly. One hospital was paid as a sole community hospital, although HCFA had not designated this facility as such.
The other hospital was designated as a sole community hospital, but reimbursed as a non-so
...le community hospital. This resulted in underpayments of 3.23 percent for Medicaid clinical laboratory services submitted by this hospital during the period.
In reviewing documentation for hospital classifications, we also determined 20 additional hospitals not selected in our sample had been incorrectly paid, one hospital was overpaid and 19 were underpaid. One hospital was approved as a sole community hospital in 1987, sixteen hospital designations changed to sole community hospitals in 1990, one was approved in 1992 and one in 1993.


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