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Outpatient cardiac rehab services under the OIG microscope

Compliance Monitor, January 21, 2004

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Medical records from a Massachusetts hospital's outpatient cardiac rehab program failed to show sufficient evidence that physicians see patients periodically throughout the program, according to a new report from the Office of the Inspector General (OIG). The report, which examined the program at Cooley Dickinson Hospital in Northampton, is one of several recent investigations the OIG has conducted in this practice area. The agency looked to determine whether Medicare properly reimbursed Cooley Dickinson for outpatient cardiac rehab services.

The OIG also reviewed a sample of 15 Medicare beneficiaries who received outpatient cardiac rehab services during 2001 and found that medical and billing records provided by the hospital in support of seven beneficiaries receiving these services totaling $1,656 did not always support the diagnoses used to establish the patients' eligibility for cardiac rehabilitation.

The OIG recommended that the hospital work with its fiscal intermediary to ensure that its outpatient cardiac rehab program is being conducted in accordance with Medicare coverage and billing requirements. Cooley Dickinson uses physicians working nearby for direct physician supervision coverage of its outpatient cardiac rehab program in the hospital and in its emergency department, the OIG reported.

For more from the OIG, click here.

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