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If approved, reviews would impact RAC Regions 1 through 4 in all states.In November 2017, the Centers for Medicare & Medicaid Services (CMS) announced that proposed Recovery Auditor (RAC) review topics would be posted. These topics, which have been proposed, but not yet approved, are available on the Medicare Provider…
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Experts warn of challenges for IRFs in FY 2020. The final rule for fiscal year (FY) 2019 for Inpatient Rehabilitation Facility (IRF) Payment has been published and there are a few changes between the proposed rule and the final one. What might be of even more interest to IRFs are…
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Those in post-acute care should frequently check for any new reports on this subject. The Centers for Medicare & Medicaid Services (CMS) sponsored an FAQ call on June 21 concerning IMPACT (Improving Medicare Post-Acute Care Transformation), which is directed by the legislation of the same name enacted in 2014. This…
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CMS guidance about medical review changes for inpatient rehabilitation facilities (IRF): Bonus or baggage? There has been lots of buzz about Medicare’s most recent clarifications to contracted auditors related to auditing therapy minutes for inpatient rehabilitation facilities (IRFs). The news first surfaced on Dec. 11 in MLN Matters SE17036, which…
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OIG report shines spotlight on area of confusion for billing. In a recent report, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) announced it has determined that Medicare inappropriately paid acute-care hospitals for outpatient services provided to beneficiaries who were inpatients of other facilities.…
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Two key areas the federal review contractors will be targeting next. An MLN Matters article published on Dec. 11 reported on a recent advisement from the Centers for Medicare & Medicaid Services (CMS) to its medical review contractors related to therapy services in Inpatient Rehabilitation Facilities (IRFs). Consistent with what…
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Testing for compliance with the CMS-13 list of diagnostic categories can be down through presumptive methodology or medical review.
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The Inpatient Rehabilitation Facility (IRFs) Prospective Payment System (PPS) final rule for the 2018 federal fiscal year was published May 3, 2017, and comments are due no later than June 26. Specifically, the final rule: Updates the federal prospective payment rates for 2018 Removes the 25-percent payment penalty for late…
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In our last article, we discussed trends in inpatient rehabilitation facility (IRF) audits and a noticeable increase in scrutiny of therapy services, particularly the intensity of therapy services. We are seeing IRF claims denied due to failure to meet the intensity-of-service requirement as well as when the preponderance of therapy…
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