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 January 1994 through December 31, 1995.
The Operation Restore Trust reviewers questioned $47,147 in charges reported for 24 of the 26 beneficiaries in our sample. This amount comprises $22,315 related to physical and respiratory therapy services rendered; $10,873 in unallowable supply charges; $1,618 in inappropriate drug payments; $788 in undocumented x-ray charges; and $11,553 for laboratory services. Therefore, we are recommending an adjustment of the above charges. In addition, we request that a focused review of physical and respiratory therapies and the use of standing orders for all 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.