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 1, 1994 through December 31, 1994.
The Operation Restore Trust reviewers questioned $7,244 in charges reported for the 27 sample beneficiaries in our study. This amount comprises $2,662 related to physical and occupational therapy services, which were not reasonable and necessary $4,209 in routine supply, and drug charges incorrectly reported as ancillary charges. Therefore, we are recommending an adjustment of the above charges.