Review of Medicare Inpatient Rehabilitation Facility Prospective Payments at Weldon Rehabilitation Hospital for Fiscal Year 2003

EXECUTIVE SUMMARY:

The objective of this review was to determine whether Weldon Rehabilitation Hospital (Weldon) billed inpatient rehabilitation facility (IRF) claims for fiscal year 2003 in compliance with Medicare prospective payment system (PPS) regulations.  We found that Weldon had established adequate procedures for completing and transmitting patient assessment instruments.  However, we found that Weldon billed 49 claims that were not in compliance with Medicare PPS regulations.  As a result, the hospital received Medicare overpayments totaling $202,872.  Overpayments occurred because Weldon did not:  (1) establish adequate controls for properly coding patient status; and (2) adhere to existing controls for billing interrupted stays.  We recommended that Weldon: (1) implement policies and procedures for correct coding of patient status codes and provide training and internal monitoring to ensure successful implementation; (2) monitor adherence to its existing controls for billing interrupted stays; and (3) refund overpayments.  Weldon agreed with our findings.