Example #1
Hospital Loss = $32,798.79 before MCA review. 

The situation:

• The patient was discharged 03-22-03 and the claim was denied on 04-16-03 with error code 34022 ("The Intermediary's record indicates that this beneficiary has coverage through a large group health plan that is primary over Medicare").
• The hospital wrote off the claim on 08-27-03.
• Large Group Health Plan coverage had actually terminated 08-21-2002 per the Common Working File (CWF), seven months before this 03-22-2003 discharge.
• MCA identified this claim as an improperly paid claim; Medicare paid the hospital $32,798.79 on 08-04-04.

Example # 2
Hospital Loss = $11,679.70 before MCA review

The situation:

• The patient was discharged 10-09-03 and the claim was denied on 10-29-03 with error code 34013 (The intermediary's records indicate that the Medicare services provided to this beneficiary are covered by workers compensation).
• The hospital wrote the claim off on 6-14-04.
• The beneficiary was over 90 years old and was not employed by anyone when the accident occurred. The Intermediary's computer system denied this claim because it involved heavy equipment.
• MCA identified this claim as an improperly paid claim; Medicare paid the hospital $11,679.70 on 06-16-2005.