Corporate Compliance

Tip: Make sure cardiac rehab billing lines up with Medicare requirements

Healthcare Auditing Weekly, February 24, 2009

The OIG recommended the following controls to ensure that all allowable cardiac services are billed and paid by Medicare in accordance with Medicare coverage and billing requirements:

  • Account supervisor discusses covered services with FI.
  • Restructure and educate the billing the office personnel regarding the Medicare coverage guidelines for cardiac rehab services to ensure that covered services provided are billed accurately, billed in a timely manner within coverage guidelines, and reimbursed by Medicare at the appropriate rate.
  • Ensure that cardiac rehab services billed for each beneficiary are within the standard limit for Medicare overage guidelines not to exceed 36 visits per patient:
    • Consult with the FI to ensure billing edits are correct and will filter overcharges before submission of claims
    • Implement quarterly sampling audit of cardiac rehab services comparing services provided, documentation present in the medical record, and charges submitted.


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