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 $284,378 in charges reported for the 32 beneficiaries in our sample. This amount comprises $245,524 related to physical, occupational, respiratory and speech therapy; $35,784 in unallowable drug, supplies, laboratory and x-ray charges; and $2,370 in Part B charges. 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.