CMS Audits of Cardiac Rehab

Please be aware that Cardiac rehab has been chosen by Centers for Medicare and Medicaid (CMS) for medical review of claims data.   A small number of CR programs around the country, including some in NC, have already received letters requesting additional documentation (an “ADR”) on multiple claims for a selected number of CR patients with varying diagnosis.  Those of you who have been through the Pulmonary rehab audits are quite familiar with this process.  Requested information closely follows required components such as physician order, diagnosis, physician prescribed exercise plan, psychological assessment, ITP, etc.

These audits are part of the auditing program that CMS has in place to evaluate Medicare services.  A Supplemental Medical Review Contractor (SMRC) conducts the review and in this case CMS contracted with Strategic Health Solutions to serve as the SMRC.  The topics and time frame for review are directed by CMS.

Please make sure that you are communicating with your business office and Health Information departments to assess whether your department has received any communication regarding audits and work with them to ensure the response to the audits reflects the good work that you do every day.  If you have questions or need assistance please don’t hesitate reaching out to your regional VP with questions.