3. We recommend that Sunrise Hospital & Medical Center strengthen controls to ensure that: (1) all IRF beneficiaries meet Medicare criteria for acute inpatient rehabilitation and all required documentation is included in the medical records, (2) all inpatient beneficiaries meet Medicare requirements for inpatient hospital services, (3) outlier payments are calculated correctly by billing the correct units of service and charges on the claim and staff are properly trained, (4) the use of bypass modifiers is supported in the medical records and staff are properly trained, and (5) HCPCS codes are supported in the medical records and staff are properly trained.
Questioned Costs
$0
Funds for Better Use
$0
Recommendation Status
Open
Source UUID
21-A-04-075-270346
Recommendation Number
270346
Significant Recommendation
No