July 8, 2010
Memorandum Report: Medicare Part B Services During Non-Part A Nursing Home Stays: Mental Health: OEI-06-06-00580
Of the mental health claims allowed by Medicare Part B during non-Part A nursing home stays in 2006, 39% did not meet program requirements for coverage. An
estimated $74 million in claims were allowed for inappropriate payments. These services did not meet requirements because they were medically unnecessary,
undocumented or inadequately documented, or miscoded. Psychotherapy accounted for the vast majority of errors related to medical necessity, documentation, and
miscoding.
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