Initial round of audits proves successful for therapy providers. Therapy providers in the Novitas JL jurisdiction have received good news on the initial round of targeted probe-and-educate (TPE) audits.  A total of 93 percent of the 102 therapy reviews received a “minor classification.” Of note, a minor classification can include…
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…
Legislation establishes the 2018 therapy cap level of $2,010 as a threshold level. The therapy caps have been eliminated! It has been a long and exhaustive 20 years of the “stop the therapy cap” campaign by members of the Therapy Cap Coalition. Finally, success! Well, sort of. In the Bipartisan…
Uncertainty persists amid the looming prospect of yet another federal government shutdown. The federal government is open for business after the House and Senate agreed on a continuing resolution to fund operations through Feb. 8, 2018 – when we presumably start all over again, ironically right after Groundhog Day. Are…
Five major areas will challenge IRF providers in 2018, including the troublesome “presumptive compliance.” Let’s face it: there are a multitude of areas that Inpatient Rehabilitation Facility (IRF) leadership must focus on every day to be successful. As we begin a new year of compliance with a plethora of regulations,…
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…
EDITOR’S NOTE: Nancy Beckley served as an invited member of the Jimmo Implementation Counsel convened by the Center for Medicare Advocacy. The therapy community, as well as those providing medically necessary skilled maintenance, now have a centralized online resource for information on the Jimmo v. Sebelius Settlement. The Centers for…
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…