Report Materials
EXECUTIVE SUMMARY:
The objective of this review was to determine whether Medicare properly reimbursed the Cooley Dickinson Hospital (Hospital) for outpatient cardiac rehabilitation services. The Hospital relies upon physicians working nearby in the Hospital and in its emergency department for direct physician supervision coverage of its outpatient cardiac rehabilitation program. However, medical record documentation we examined showed little evidence that a physician personally sees a patient periodically throughout the program. In addition, we reviewed a sample of 15 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 seven beneficiaries receiving cardiac rehabilitation services totaling $1,656 did not always support the diagnoses used to establish the patients' eligibility for cardiac rehabilitation. We recommended that the Hospital work with the FI to ensure that the Hospital's outpatient cardiac rehabilitation program is being conducted in accordance with Medicare coverage and billing requirements. The Hospital generally agreed with our recommendations.
Notice
This report may be subject to section 5274 of the National Defense Authorization Act Fiscal Year 2023, 117 Pub. L. 263.