Office of Mental Health

Controls Over Outpatient Billings

As part of its integrated system of mental health care, the Office of Mental Health (OMH) provided outpatient services to an average of 12,700 outpatients per month during the 1998-1999 fiscal year at its mental health facilities throughout the State. The cost of these services is reimbursable by Medicaid, Medicare and third party health insurers. Our audit found that OMH needs to improve procedures at its facilities to increase the likelihood that reimbursement is obtained for services provided to outpatients. At the six facilities we visited, some billed services were not documented in the patients' medical records and other services were not billed. We also found that the time to submit bills varied significantly from facility to facility. Nine facilities averaged over 90 days between the visit date and the date the bill was submitted for payment. We recommend that OMH take steps to ensure services are documented in patients' medical records, and establish procedures to verify the accuracy of data entered on the billing system. We also recommend that OMH investigate billing variances among facilities and take steps to ensure that facilities submit bills promptly.

For a complete copy of Report 99-S-31 click here
For a copy of the 90-day response click here.
For a copy of the associated follow-up report click here.