Performance Improvement 2008. Do Medicare Carriers Correctly Calculate Copayments for Mental Health Services Rendered to Those With Alzheimer's Disease?


This study determined the extent to which Medicare carriers: consistently calculated beneficiary copayments for mental health services and correctly calculated copayments for mental health services rendered to beneficiaries diagnosed with Alzheimer's disease or related disorders. Researchers surveyed (by mail, telephone, and e-mail) the carriers and analyzed a one-percent sample of claims for the Medicare National Claims History for services rendered from 2001 through 2004. Researchers reviewed all relevant statutes, regulations, and Federal guidance.

In some areas beneficiary copayments for the same mental health service were more than double what they were in other areas. Carriers´ payment policies were inconsistent; they did not uniformly apply the outpatient mental health treatment limitation. Carriers overstated copayments for beneficiaries with Alzheimer's disease and related disorders by approximately $27 million during the 4-year period analyzed.

Report Title: Carrier Determination of Copayments for Medicare Mental Health Services,
Agency Sponsor: OS-OIG, Office of Inspector General
Federal Contact:
Claire Barnard, 202-205-9523
Performer: Office of Inspector General

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"PerformanceImprovement2008.pdf" (pdf, 1.29Mb)

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