Review of Outpatient Cardiac Rehabilitation Services at Pottsville Hospital, Pottsville, Pennsylvania

EXECUTIVE SUMMARY:

The objective of this review was to determine whether Medicare properly reimbursed Pottsville Hospital (Pottsville) for outpatient cardiac rehabilitation services.  Even though physician supervision is assumed to be met in an outpatient hospital department, Pottsville contracted with two physicians to supervise the services provided by its cardiac rehabilitation program.  The physicians' responsibilities included approving the cardiac rehabilitation plans of care and reviewing patients' medical records.  However, our review disclosed that the physicians generally were not in the exercise area during regularly scheduled exercise sessions, nor did they generally see the patients. In addition, from our specific claims review for a sample of 30 beneficiaries who received outpatient cardiac rehabilitation services during CY 2001, we determined that Pottsville received Medicare payments of $395 for services where the diagnoses used to establish the patients' eligibility for cardiac rehabilitation may not have been supported by medical records and for services not otherwise allowable.