Exhibit: Attachment to the Part A Letter Notifying the Provider of the

7.3.1 - Exhibit: Attachment to the Part A Letter Notifying the Provider of the Results, and Request Repayment of Overpayments (Rev.) The following is a list of claims denied as a result of the review: A. Beneficiary Name: John Smith 1. HI Claim Number: 000-00-0000 A 2. Service Dates: 12/01/96 - 01/15/97 3. Services Denied and Dates: 45 Inpatient SNF Days, 12/1/96 - 1/15/97 4. Reason for Denial: The therapy services rendered were not medically reasonable and necessary because they were for overall fitness and general well being and did not require the skills of a qualified physical therapist ( §1879 denial). (Provide details that led you to the conclusion that the services were non-skilled.) 5. Why You Are Responsible: We find that you knew or should have known that payment would not be made for such items or services under Part A, and you are not without fault in accordance with §1870 of the Social Security Act. We believe you knew or should have known that the services were not medically reasonable and necessary because of the educational contacts made in July 1996 and October 1996 regarding Medicare coverage of therapy services. In these contacts numerous similar examples were cited as noncovered. Therefore, you are responsible for paying the overpayment amount. 6. Overpayment: $2,000.00 B. Beneficiary Name: Mary Smith 1. HI Claim Number:000-00-0000 B 2. Service Dates: 01/01/97 - 01/31/97 3. Services Denied and Dates: 31 Inpatient SNF Days, 01/01/97 - 01/31/97 4. Reason for Denial: There was no skilled care furnished on a daily basis. Skilled therapy services were furnished 2-3 times a week, although therapy is available in your facility on a daily basis. 5. Why You Are Responsible: We find that you knew or should have known that payment would not be made for such items or services under Part A, and you are not without fault in accordance with §1870 of the Social Security Act. The Medicare coverage guidelines in the SNF manual clearly state the requirement for daily skilled services. You were also notified in educational contacts in July 1997 and October 1997 of similar cases. Therefore, you are responsible for the overpayment. 6. Overpayment: $200.00