Review Of Outpatient Cardiac Rehabilitation Services at Orange Regional Medical Center - Horton Campus

EXECUTIVE SUMMARY:

The objective of this review was to determine whether Medicare properly reimbursed the Orange Regional Medical Center ' Horton Campus (Hospital) for outpatient cardiac rehabilitation services.  Medical record documentation we examined showed no evidence that a physician personally sees a patient periodically throughout the program.  In addition, we reviewed a sample of 30 Medicare beneficiaries who received outpatient cardiac rehabilitation services during calendar year 2001 totaling $11,678.  We found that medical and billing records provided by the Hospital for 26 beneficiaries receiving cardiac rehabilitation services did not always support services performed.  We recommended that the Hospital work with the fiscal intermediary to ensure that the Hospital's outpatient cardiac rehabilitation program is being conducted in accordance with Medicare coverage and billing requirements.