Which database identifies suspicious billing and charge practices submitted by fiscal intermediaries?

• A. PQRS
• B. ORYX
• C. MEDPAR Medicare Provider Analysis and Review
• D. MS-DRG

Answer: (C)

The correct choice identifies the MEDPAR (Medicare Provider Analysis and Review) database, which is specifically designed to analyze and review Medicare provider data. This database includes information on patient stays in hospitals and has a robust mechanism for identifying unusual billing patterns and potentially suspicious charge practices. By examining administrative and clinical data, MEDPAR helps in assessing whether billing practices align with the services rendered, therefore allowing for the identification of discrepancies that could signal fraudulent activity or improper billing by fiscal intermediaries.

This focus on ensuring billing integrity is a cornerstone of quality control in healthcare financing, making MEDPAR an essential tool for recognizing trends that may require further investigation. The database's ability to compile and evaluate this information effectively supports compliance and regulatory efforts aimed at safeguarding the Medicare program against abuse.