Outpatient cardiac and pulmonary rehab claims added to OIG Work Plan

The Office of Inspector General (OIG) plans to put Medicare Part B payments for outpatient cardiac and pulmonary rehabilitation under the microscope, according to the agency’s recently updated Work Plan.

Although outpatient cardiac and pulmonary rehabilitation services are eligible for Part B payment, the services must meet CMS’ medical necessity requirements. In addition, certain documentation must be present in the patient’s medical record. The OIG will begin to review payments for these services to determine whether providers actually measured up to CMS’ requirements, identify potential over- or underpayments, and will analyze risks in outpatient cardiac and pulmonary rehabilitation programs.

The OIG noted that outpatient cardiac and pulmonary rehabilitation claims did not always comply with CMS’ requirements in previous reports. Although the Work Plan update does not cite any specific report, concerns regarding appropriate payment for these services cropped up in a number of reports from the past several years, such as 2014 report that identified $115,000 in overpayments to a New Jersey hospital.

For more information on CMS’ requirements for outpatient cardiac and pulmonary rehabilitation, see Chapter 15 of the Medicare Benefit Policy Manual, Chapter 32 of the Medicare Claims Processing Manual, and Chapter 1 of the Medicare National Coverage Determinations Manual.