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Extracted from Consolidated Report
This investigation was originally published as part of a larger consolidated report containing multiple investigations. View the consolidated PDF for the complete document.
Los Angeles County Grand Jury
• 2013-2014
3. Career and Job Preparedness in Public High Schools
⚠️ Translation Notice: This content has been automatically translated. The original English text is the official version. Translation may contain errors.
⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
Findings 5 findings
F8
Page 79
Overall, Medicare gross charges of the Incomplete or No Medical Documentation write-offs are the highest among all payers, accounting for $101.6 million in DHS gross charge write-offs between Fiscal Years 2008-09 and 2012-13.
F9
Page 79
The audit sample of Incomplete or No Medical Records write-offs demonstrated key trends that aligned with problems reported by DHS staff involved in managing and executing the patient billing processes.
F10
Page 79
Approximately $24.5 million in gross charge write-offs between FY 2009-10 and 2012-13 was attributed to physicians without National Provider Identifier numbers and required authorization with DHS for billing of services to Medicare.
F11
Page 79
Barriers or complications in coding accounts by Health Information Management divisions.
F12
Page 79
Coding backlogs in Health Information Divisions.
Recommendations 2
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R1Page 74Outpatient services include emergency and urgent care services.
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R2Page 74The Ambulatory Care Network consists of the Multi-Service Ambulatory Care Centers, Comprehensive Health Centers, and Health Centers DHS patients whose services are reimbursed by a third party are generally covered by Medi-Cal and Medi-Cal Managed Care. These programs require authorization for services provided outside of the health plan’s network. The majority of No Authorization for Services write-offs, is attributed to Medi-Cal Managed Care patients. A total of $58,567,426 of the $68,247,160, or 85.8 percent of write-offs due to No Authorization for Services over the past five fiscal years, was for Medi-Cal Managed Care inpatients, outpatients and ambulatory care network patients. Medi-Cal Managed Care and private insurance companies will reimburse DHS for services provided if authorization is obtained in a 60 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT