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The CMS proposal to eliminate the Inpatient-Only List, does not mean that all procedures are to be performed as outpatient. On Jan. 18, 2018, RACmonitor published my article titled “CMS Says OK to Admit Total Knee Replacements as Inpatient.” The title created a bit of an uproar, as many thought…
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With an expected ramp-up in audits and denials for care across all healthcare services in the coming months, we continue to hear questions related to how Medicare views “medical necessity” for an inpatient rehabilitation facility (IRF) stay. And we continue see issues arise over an acute, biased definition of “medical…
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The Coronavirus Aid, Relief, and Economic Security (CARES) Act signed into law on March 27 included provisions that would waive the requirement that a Medicare beneficiary be expected to participate in at least three hours of intensive therapy, at least five days per week. This provision would improve patient access…
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The audit environment is unlikely to improve. On Monday, Jan. 14, the Monitor Mondays panel of experts came together to celebrate the 10th anniversary of the launch of the weekly broadcast, and we provided our listeners with some perspective on what to expect in the coming year. The following is…
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Changes are effective Oct. 1, 2019. With fewer than 30 days remaining before the transition of payment for inpatient rehabilitation facility (IRF) services to the new formula based on the use of Quality Indicator Data, providers should be winding down their preparations and simply fine-tuning processes. Patients discharged on or…
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The CMS Administrator could have chosen a better example to highlight plans for lower costs during recent remarks. With the release of the 2020 Inpatient Prospective Payment System (IPPS) Final Rule and the 2020 Outpatient Prospective Payment System (OPPS) and Medicare Physician Fee Schedule rules, Centers for Medicare & Medicaid…
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Changes are effective Oct. 1, 2019 In this article, we aim to continue to remind Inpatient Rehabilitation Facilities (IRFs) of the looming transition from utilizing Functional Independence Measures (FIMtm) for the purposes of assigning patients to a case-mix group (CMG) to the use of key quality indictor data – specifically…