Report Materials
EXECUTIVE SUMMARY:
The primary objective of the review was to evaluate the medical necessity of the care and services provided and the reasonableness of the charges and reimbursements made during the period from January 1994 through December 31, 1995.
The Operation Restore Trust reviewers questioned $52,318 in charges reported by the skilled nursing facility (SNF) that did not meet Medicare reimbursement guidelines as stated above for 22 of the 24 beneficiaries in the sample. The disallowed cost consists of $35,513 for occupational, physical, speech and respiratory therapy services; $1,068 of charges for psychological services; $10,620 for supply services; $1,964 for laboratory services and $3,153 of charges for x-rays and other tests that were not medically necessary, undocumented or not covered by Medicare. Therefore, we are recommending an adjustment of the above charges. In addition, we request that a focused review of all occupational therapies since the period of our review and the use of standing orders for all therapies be conducted by the Fiscal Intermediary and State agency in order to recoup overpayments made to this SNF and to implement corrective action by the facility.
Notice
This report may be subject to section 5274 of the National Defense Authorization Act Fiscal Year 2023, 117 Pub. L. 263.