Review of Fiscal Year-End Billing for Inpatient Rehabilitation Claims Under the Administrative Responsibility of AdminaStar Federal for 2002

The objective of our review was to determine whether inpatient rehabilitation facilities (IRFs) under the administrative responsibility of AdminaStar Federal (AdminaStar) billed fiscal year-end inpatient rehabilitation claims in accordance with Medicare requirements during the transition to the prospective payment system in 2002. Twenty IRFs did not bill fiscal year-end claims in accordance with Medicare requirements. As a result, Medicare made net overpayments of $272,564. Some IRFs did not have adequate controls to ensure that claims submitted at fiscal year-end were billed accordance with Medicare requirements, and several IRFs stated that they had received inaccurate information from AdminaStar.

We recommended that AdminaStar make the appropriate adjustments to paid claims that resulted in net overpayments of $272,564 to the 20 IRFs and continue education efforts for IRF and AdminaStar personnel. AdminaStar agreed with our recommendations.