Office of Medicaid (MassHealth) - Review of Radiology Claims Submitted by Baystate Mary Lane Hospital
July 27, 2015 · Office of Medicaid (MassHealth) · Read the full official report (PDF) ↗ · official site ↗
Published July 27, 2015 Audit covers January 1, 2013 – December 31, 2014 Under Suzanne M. Bump · 2011–2023
source
“Based on our audit, we have concluded that Baystate Mary Lane Hospital properly documented radiological services it provided to MassHealth members.”
Read the plain-English breakdown
This is a Massachusetts State Auditor review of radiology claims that Baystate Mary Lane Hospital submitted to MassHealth for services during 2013 and 2014.
“The Office of the State Auditor has conducted an audit of Baystate Mary Lane Hospital’s claims for radiological services provided to MassHealth members for the period January 1, 2013 through December 31, 2014.”
Auditors checked whether the hospital had enough medical records to justify the radiology bills it sent to MassHealth.
“The purpose of this audit was to determine whether Baystate Mary Lane Hospital properly documented radiological services in accordance with applicable laws, rules, and regulations.”
MassHealth is a very large public healthcare program, so proper billing and documentation affect taxpayer-funded spending.
“In fiscal year 2014, MassHealth paid healthcare providers more than $11.9 billion, of which approximately 47% was funded by the Commonwealth.”
If you are a Massachusetts resident, this audit is about whether public healthcare dollars were supported by records before being paid out.
“Currently, Medicaid expenditures represent approximately 34% of the Commonwealth’s total annual budget.”
The hospital passed the audit objective: it had adequate documentation for the radiology claims reviewed.
“Does Baystate Mary Lane Hospital maintain adequate documentation to support its claims for radiological services provided to MassHealth members?”
The report does not list corrective actions because auditors did not find significant deficiencies in the documentation they reviewed.
“We did not identify any significant deficiencies in this area.”
Auditors reviewed a focused slice of about $583,848 in MassHealth-paid radiology services at a hospital that received about $3 million from MassHealth during the audit period.
“These services are included within Outpatient Services above and totaled $583,848 during the audit period.”
“Radiological services” means imaging services such as X-rays, mammograms, ultrasounds, and similar tests.
“Radiological services include X-rays, mammograms, ultrasounds, and other services.”
What the Auditor checked
- Complied Does Baystate Mary Lane Hospital maintain adequate documentation to support its claims for radiological services provided to MassHealth members?
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