News Alert: CMS Notifies IRFs of Non-Compliance with Quality Reporting Requirements: How to Respond

Facilities that received a notice of non-compliance and believe the notice is in error must respond by Aug. 7, 2018

The Centers for Medicare & Medicaid Services (CMS) announced on July 6 that notifications to facilities that were determined to be out of compliance with the Inpatient Rehabilitation Facility (IRF) Quality Reporting Program (QRP) requirements for 2017 would be mailed and placed into the facilities’ Certification And Survey Provider-Enhanced Reports (CASPER) folders.

Facilities that received a notice of non-compliance and believe the notice is in error have only until Aug. 7, 2018 to submit a request for reconsideration. Note that the date in letters and the date in the posted notice may differ slightly from what is noted on the CMS web page regarding reconsiderations, so we advise that you use the Aug. 7 date.

The notices arriving at IRFs in our client base triggered calls for assistance with this issue. To assist other IRFs, we have prepared this article to provide you with the steps to take in order to request a reconsideration.

How Were IRFs Notified?

Notifications should occur in two ways:

• They were placed in facilities’ CASPER folders via the Quality Improvement and Evaluation System (QIES) on July 9; and
• They were also mailed to the current authorized official(s) at the IRFs (letters we have seen were dated a few days later).

If you are uncertain if you received a letter due to processing time for mail, check your CASPER folder today!

What Triggers the Notice?

IRFs are required to submit quality data both through the IRF-PAI that is transmitted to the QIES system and to the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN). Both sets of data have time requirements and requirements for completion of the data elements. Failure to meet time or data content mandates will result in a determination of non-compliance. The period of time involved for this data set was 2017.

What’s the Impact?

IRFs that fail to meet the reporting requirements are subject to a 2 percent reduction in the 2019 fiscal-year annual increase factor, which impacts reimbursement for all Medicare fee-for-service (FFS) claims during that period.

Because of this impact, we strongly urge IRFs that believe they comply to request a reconsideration if it appears that at least some of these determinations were made in error.

How Do We Request a Reconsideration?

• Reconsideration requests are only accepted via email at IRFQRPreconsiderations@cms.hhs.gov.
• Questions about the process and about what documentation is acceptable can also be addressed to this email account.
• Submit your request on or before Aug. 7, 2018.
• The following detail has been copied directly from the CMS website to assist you including the correct data:

Reconsideration Request Process

To apply for reconsideration, the IRF must receive a CMS letter of non-compliance. An IRF disagreeing with the payment reduction decision may submit a request for reconsideration to CMS within thirty (30) days from the date at the top of the non-compliance notification letter distributed electronically using QIES. CMS will not accept any requests submitted after the thirty (30) day deadline.

Create a Reconsideration Request

Please note: The only method for submitting reconsideration requests is via email. Requests submitted by any other means will not be reviewed for reconsideration.

IRFs are required to submit their request to CMS via email with the subject line: “IRF ACA 3004 Reconsideration Request” and include the IRF CMS Certification Number (CCN) (e.g., IRF ACA 3004 Reconsideration Request, XXXXXX). The request must be sent to the following email address: IRFQRPReconsiderations@cms.hhs.gov.

The email request must contain the following information:

• IRF CMS Certification Number (CCN)
• IRF Business Name
• IRF Business Address
• CEO or CEO-designated representative contact information, including: name, email address, telephone number, and physical mailing address
• CMS identified reason(s) for non-compliance from the non-compliance notification letter
• Information supporting the IRF belief that either non-compliance is in error, or evidence of the impact of extraordinary circumstances which prevented timely submission of data

The request for reconsideration must be accompanied by supporting documentation demonstrating compliance. CMS will be unable to review any request that fails to provide the necessary documentation along with the request for reconsideration. Supporting documentation may include any or all of the following:

• Proof of submission
• Email communications
• Data submission reports from the Quality Improvement Evaluation System (QIES)
• Data submission reports from the National Healthcare Safety Network (NHSN)
• Proof of approved exception or extension for the reporting time frame
• Copy of the CCN activation letter
• Other documentation supporting the rationale for seeking reconsideration

IMPORTANT: Never include patient information (i.e. protected health information (PHI), patient identifiable information (PII), or other Health Insurance Portability and Accountability Act (HIPAA) violation) in the documentation being submitted to CMS for review.  Submitting patient-level data or protected health information may be a violation of your facilities’ policies and procedures as well as violation of federal regulations (HIPAA).

What’s the Bottom Line?

IRFs need to investigate any determinations related to compliance, whether they were associated with reporting requirements or claims denials, as there is often good evidence to support a reversal of a negative decision.

Program Note

Listen to Angela Phillips report this story on Monitor Monday July 23, 10-10:30 a.m. PT.

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