Review Of Fiscal Year-End Billing For Inpatient Rehabilitation Facility Claims At MaineGeneral Medical Center For 2002, 2003 and 2004

EXECUTIVE SUMMARY:

The objective of our review was to determine whether MaineGeneral Medical Center (the hospital) billed fiscal year-end inpatient rehabilitation facility (IRF) claims for 2002-2004 in accordance with Medicare regulations.  The hospital did not bill fiscal year-end claims for its IRF in accordance with Medicare regulations.  As a result, Medicare made net overpayments totaling $254,915.  The hospital received inaccurate information from its fiscal intermediary that contributed to the problem of split billing in 2003 and 2004. 

We recommended that the hospital improve controls to ensure that current Medicare billing guidelines are followed.  We also recommended that the hospital continue to work with its fiscal intermediary to complete the voluntary repayment process involving the net overpayments of $254,915 and determine the resulting effect on its Medicare cost reports for 2002 - 2004.  The hospital agreed with our recommendations.

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