Review of Fiscal Year-End Billing For Inpatient Rehabilitation Facility Claims Under The Administrative Responsibility Of Palmetto GBA For 2002

EXECUTIVE SUMMARY:

Our objective was to determine whether inpatient rehabilitation facilities (IRFs) under the administrative responsibility of Palmetto, GBA (Palmetto) billed fiscal year-end inpatient rehabilitation claims in accordance with Medicare requirements during the transition to the prospective payment system in 2002.  Eleven IRFs did not bill fiscal year-end claims in accordance with Medicare requirements.   As a result, Medicare made net overpayments of $207,289.  Most of the payment errors occurred because the IRFs did not have adequate controls to ensure that claims submitted at fiscal year-end were billed in accordance with Medicare requirements.  Additionally, several IRFs stated that they had split their claims as a result of discussions with Palmetto or in response to error messages received from the claims processing system.  We were unable to validate these assertions.

We recommended that Palmetto make the appropriate adjustments to paid claims that resulted in net overpayments of $207,289 to the 11 IRFs and continue education efforts for IRF and Palmetto personnel.  Palmetto agreed with our recommendations.

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