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Gov't audit insider: Outpatient cardiac rehabilitation services

Healthcare Auditing Weekly, September 9, 2003

This Office of Inspector General (OIG) review is part of a nationwide analysis of Medicare reimbursement for outpatient cardiac rehabilitation services.

The OIG's objective for this review was to determine whether Medicare properly reimbursed Washington Adventist Hospital (WAH) for outpatient cardiac rehabilitation services. The OIG did the following to accomplish its objective:

1. Compared WAH's policies and procedures for outpatient cardiac rehabilitation to national coverage requirements and then identified any differences

2. Documented how WAH provided direct physician supervision for cardiac rehabilitation services and verified that WAH's cardiac rehabilitation program personnel were qualified in accordance with Medicare requirements

3. Verified the availability of advanced cardiac life support equipment in the cardiac rehabilitation exercise area
4. For each sampled beneficiary, the OIG obtained the calendar year 2001 Medicare outpatient cardiac rehabilitation paid claims and lines of services, and then compared this data to WAH's outpatient cardiac rehabilitation service documentation

5. The OIG reviewed the medical records maintained by the cardiac rehabilitation program to determine whether services were provided "incident to" a physician's professional service

6. Verified the accuracy of the diagnoses identified on the Medicare claims to the beneficiary's hospital medical record, the referring physician's referral and medical record, and WAH's outpatient cardiac rehabilitation medical record

7. Verified that Medicare did not reimburse WAH beyond the maximum number of services allowed

8. Determined why the Centers for Medicare and Medicaid Services requested a nationwide analysis, as well as the extent to which the provider was currently complying with existing Medicare coverage requirements

Click here to read this audit report.

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