Review of Outpatient Cardiac Rehabilitation Services - St. Charles Mercy Hospital, Oregon, Ohio

EXECUTIVE SUMMARY:

This review was part of a nationwide analysis of Medicare reimbursement for outpatient cardiac rehabilitation services.  The objective of the review was to determine whether Medicare properly reimbursed St. Charles Mercy Hospital (Hospital) for outpatient cardiac rehabilitation services.  Our review disclosed that the Hospital did not designate a physician to directly supervise the services provided by its cardiac rehabilitation program.  In addition we could not identify the physician professional services to which the cardiac rehabilitation services were provided “incident to.”  Also, the Hospital claimed and received Medicare reimbursement for outpatient cardiac rehabilitation services which did not meet Medicare coverage requirements, which may not have been supported by medical record documentation, or which were otherwise unallowable.  We recommended that the Hospital: (1) work with its fiscal intermediary, AdminaStar, to ensure that the Hospital's outpatient cardiac rehabilitation program is being conducted in accordance with the Medicare coverage requirements for direct physician supervision and for services provided “incident to” a physician's professional service; (2) work with AdminaStar to establish the amount of repayment liability for services provided to beneficiaries where medical documentation may not have supported Medicare covered diagnoses and for services not otherwise allowable; (3) implement controls to ensure that medical record documentation is maintained to support Medicare outpatient cardiac rehabilitation services; and (4) implement controls to ensure that only one unit of service is billed to Medicare for each cardiac rehabilitation session provided.