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OIG recommends that CMS clarify cardiac rehab rules

Compliance Monitor, September 7, 2005

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The OIG has recommended that CMS clarify national Medicare cardiac rehabilitation coverage requirements.

The recommendation is the result of a review of 34 outpatient rehabilitation facility audits. The objective of the review was to determine whether the hospitals had complied with cardiac rehabilitation coverage requirements for direct physician supervision and "incident to" services.

The OIG found hospitals inconsistently interpreted reimbursement rules. Twenty-nine of the 34 hospitals surveyed relied on emergency physicians or "code" teams in other parts of the hospitals to provide physician supervision when the medical directors were not available. The remaining five hospitals designated a particular physician to provide direct physician supervision.

Thirty-two of the 34 hospitals considered the patient's referring physician as the physician whose services the rehabilitation was provided "incident to." The other two hospitals relied on the professional services of a hospital physician.

The OIG attributed these inconsistencies to inconsistent guidance in the Medicare Coverage Issues Manual, Hospital Manual, and Intermediary Manual.

Click here to read the report in its entirety.

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