Eli's Rehab Report

Published on Sun Jan 01, 2006 PDF

If you're a comprehensive outpatient rehabilitation facility, you might want to re-examine your billing practices.

The HHS Office of Inspector General (OIG) certainly found issues with CORF ABC Total Rehabilitation Care Inc.'s Medicare therapy payments.

Out of 88 sampled claims, ABC received $27,602 in unallowable payments for therapy services and submitted 1,570 services that did not meet Medicare reimbursement requirements. The OIG estimates that ABC received a total of $226,673 for unallowable services. 

The problem: The reasons claims failed to meet Medicare reimbursement requirements were that  therapists rendered the billed services outside the approved plan of care, the services did not meet Medicare duration-of-therapy requirements, the documentation did not meet Medicare standards to support that services were actually provided, and the services were not medically necessary.

The OIG recommended that ABC refund the Medicare program the $226,673 in payments that did not meet Medicare reimbursement requirements.