Health systems are grappling with custodial/social admissions from the ED. A specific quandary is playing out in emergency departments (EDs) all over the country, and no one seems to have a clear answer on how to address it. The situation? Patients presenting to EDs because they are unable to care…

At issue: hospital overpayments of $54.4 million. There has been recent talk on an online user group that many hospitals have had recoupments of payment for inpatient admissions from 2016 to 2018 due to an “incorrect discharge status code.” This appears to be in response to a November 2019 audit…

CMS is expected to release instructions and sub-regulatory guidance in 2020. It was way back in 2015 when the Centers for Medicare & Medicaid Services (CMS) proposed changes to the discharge planning conditions of participation. Their goal was noble; they understood that because discharge planning is a complex process, a…

Compliance is mandatory, but data from CMS remains unavailable at this time. The discharge planning day of reckoning is today, Black Friday, Nov. 29, 2019 – and yet, as of this reporting, the only source of data, the Centers for Medicare & Medicaid Services (CMS) Compare website, still has no…

We have been reminding inpatient rehabilitation facilities (IRFs), repeatedly of late, and now we’re down to the final two months before the transition away from utilizing Functional Independence Measures (FIMtm) to assign patients to a case-mix group (CMG) and toward using key quality indictor data – specifically, the GG Self-Care…

There’s an updated version of the IRF-PAI manual. As we prepare for changes in how inpatient rehabilitation facilities (IRFs) are paid through the utilization of quality indicator data rather than Functional Independence Measure (FIMTM) scores to classify patients into appropriate case-mix groups (CMGs), it’s important that IRFs provide the most…

IRFs can breathe easier; no change in policy. CMS has clarified the question of counting minutes of therapy provided by students. The Inpatient Rehabilitation Facility (IRF) world reacted in shock to an unexpected statement made during a November Medicare Learning Network call wherein a Centers for Medicare & Medicaid Services…

A brewing problem, or simply an area for clarification for IRFs?   During what was expected to be a plain vanilla review of the Inpatient Rehabilitation Facility Prospective Payment Systems (IRF-PPS) Coverage Requirements and Updates from the FY 2019 Final Rule, the Centers for Medicare & Medicaid Services (CMS) made…

CMS provides Medicare waivers for providers dealing with natural disasters. I live in North Carolina, and as most of you have seen on the news, we just underwent a natural disaster. Its name is Hurricane Florence. Our Governor has declared a state of emergency, and this declaration is extremely important…

RAC issue for IRFs has moved from being proposed to being approved. The Centers for Medicare & Medicaid Services (CMS) recently posted a potential Complex Medical Review for (inpatient rehabilitation facilities) IRFs. The issue: 0A024-Inpatient Rehabilitation Facility (IRF) Stays: Meeting Requirements in the proposed Recovery Audit Contractors (RAC) Topics list…