Corporate Compliance

Gov’t audit insider: Outpatient cardiac rehabilitation services

Healthcare Auditing Weekly, October 14, 2003

The Office of Inspector General (OIG) performed this review as part of a nationwide analysis of Medicare reimbursement for outpatient cardiac rehabilitation services. Its objective was to determine whether Medicare properly reimbursed Deaconess Hospital (DH) for outpatient cardiac rehabilitation services.

The OIG took the following steps as part of its audit:

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

2. Documented how DH's staff provided direct physician supervision for cardiac rehabilitation services and verified that DH'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. Obtained, for each beneficiary, the calendar year 2001 Medicare outpatient cardiac rehabilitation paid claims and lines of service, and then compared this data to DH's outpatient cardiac rehabilitation service documentation.

5. Reviewed all of the cardiac rehabilitation program's medical records 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 by comparing them to each beneficiary's inpatient medical record, the physician referral, and DH's outpatient cardiac rehabilitation medical record.

7. Determined whether Medicare reimbursed DH beyond the maximum number of services allowed.

To read the audit report "Review of Deaconess Hospital Outpatient Cardiac Rehabilitation Services," click here.

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