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EXECUTIVE SUMMARY:
The objective of this review was to determine whether Medicare properly reimbursed Holy Cross Hospital (Holy Cross) for outpatient cardiac rehabilitation services. Holy Cross met Medicare’s requirements for (1) direct physician supervision and (2) providing “incident to” services. Specifically, Holy Cross contracted with two physicians to directly supervise the services provided by its cardiac rehabilitation program.. The physicians’ responsibilities included the daily supervision of the cardiac center, patients’ initial physical assessment, approval of cardiac rehabilitation treatment plans, and observation of patients’ daily progress. One of the physicians was always in the exercise area during regularly scheduled exercise sessions. In addition, from our specific claims review for a sample of 30 beneficiaries who received outpatient cardiac rehabilitation services during Calendar Year 2001, we determined that Holy Cross received Medicare payments of $7,470 for services where the diagnoses used to establish the patients’ eligibility for cardiac rehabilitation may not have been supported and for services not otherwise allowable.