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Gov't audit insider 12/23/04: Review of cardiac rehab services at the Wilson N. Jones Medical Center.

Healthcare Auditing Weekly, December 23, 2003

The Office of Inspector General's (OIG) objective for this audit was to determine whether Medicare properly reimbursed Wilson N. Jones Medical Center for outpatient cardiac rehabilitation services. To accomplish these objectives, the OIG used the following methodology:

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

2. Determined whether the hospital's staff provided direct physician supervision for cardiac rehabilitation services.

3. Verified that the hospital's personnel were qualified in accordance with Medicare requirements.

4. Verified the availability of advanced cardiac life support equipment in the cardiac rehabilitation exercise area.

5. For each sampled beneficiary, the OIG obtained calendar year 2001 Medicare outpatient cardiac rehabilitation paid claims and lines of service.

6. Compared the paid claims and lines of services to the hospital outpatient cardiac rehabilitation service documentation.

7. Reviewed the medical records maintained by the cardiac rehabilitation program to determine whether services were provided "incident to" a physician's professional service.

8. Verified the accuracy of the diagnoses identified on the Medicare claims by reviewing the hospital's outpatient cardiac rehabilitation medical records, the physician referrals, and the beneficiaries' inpatient medical records and/or referring physician's medical records.

9. Verified that Medicare did not reimburse the hospital beyond the maximum number of services allowed.

Click here to read the audit report "Review of Wilson N. Jones Medical Center Cardiac Rehabilitation Services." Wilson N. Jones Medical Center is located in Sherman, TX.

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