Review of Trans-Telephonic Cardiac Monitoring Services Provided By Raytel Cardiac Services, Inc. for Calendar Year 2002

EXECUTIVE SUMMARY:

The objective of our audit was to determine whether Medicare payments to Raytel Cardiac Services, Inc. for trans-telephonic cardiac monitoring services were allowable and made in accordance with applicable Federal regulations and guidelines.  We found that Raytel received improper payments totaling $12,315 in calendar year 2002.  These improper payments included (1) $11,666 in duplicate payments for services that were reimbursed under both a local procedure code and a Common Procedural Terminology (CPT) code, and (2) $649 for services that did not comply with Medicare requirements.  We did not question Medicare reimbursements for the services performed by Raytel technicians who lacked certification or licenses from a State or national accreditation body.  The States in which Raytel operated did not require licenses for pacemaker technicians, and the carrier did not issue guidelines for certification until after our audit period.

We recommended that Raytel:  (1) refund to the Medicare carrier $12,315 for duplicate payments received for billing the same service using both a local procedure code and a CPT code, and for services that did not comply with Federal regulations or Medicare guidelines, (2) examine the errors identified in our review and develop additional controls and training to ensure that these types of errors do not occur in the future, and (3) work with the carrier to ensure that its pacemaker training program is in compliance with the carrier guidelines for trans-telephonic monitoring personnel.  Raytel did not concur with our findings as stated in the draft report.  Raytel refunded $11,788 of the $12,315 it received in duplicate payments and payments for services improperly billed.