Report Materials
EXECUTIVE SUMMARY:
The primary objective of the review was to evaluate the medical necessity of the care and services provided and the reasonableness of the charges and reimbursements made during the period from November 1, 1994 through December 31, 1995.
The Operation Restore Trust reviewers questioned $76,130 in charges reported for the 12 sampled beneficiaries in our study. This amount consists of $75,472 related to physical occupational and speech therapy services rendered; $234 in unallowable pharmacy charges, $312 in inappropriate physician payments and $658 in other services billed to the Part B carrier. Therefore, we are recommending an adjustment of the above charges. In addition, we request that a focused review of all rehab therapies and the use of standing orders for these therapies be conducted by the fiscal intermediary and State agency in order to recoup overpayments made to this skilled nursing facility and to implement corrective action by the facility.
Notice
This report may be subject to section 5274 of the National Defense Authorization Act Fiscal Year 2023, 117 Pub. L. 263.