Review Of Outpatient Cardiac Rehabilitation Services at Robert Wood Johnson University Hospital Hamilton

EXECUTIVE SUMMARY:

The objective of this review was to determine whether Medicare properly reimbursed the Robert Wood Johnson University Hospital Hamilton (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 10 Medicare beneficiaries who received outpatient cardiac rehabilitation services during calendar year 2001.  We found that medical and billing records provided by the Hospital in support of eight beneficiaries receiving cardiac rehabilitation services totaling $4,575 did not always support services performed, as well as the diagnoses used to establish the patients' eligibility for cardiac rehabilitation.  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.  The Hospital agreed with our recommendation.