Proposed rule would ease IRF reporting, documentation requirements

May 16, 2018
Medicare Web

CMS is looking to reduce reporting and documentation requirements for inpatient rehabilitation facilities (IRF) in the 2019 IRF payment system proposed rule, published in the Federal Register May 8. The proposed changes could come as a relief to IRFs that have seen a significant uptick in audits and denials.

The goal of the 2019 proposed rule is to shift the focus from the minutiae of process and prioritize patient needs and how care is actually delivered, CMS said in a press release. Some of the highlights of the proposed rule include:

  • Changes to IRF coverage requirements that would allow the post-admission physician evaluation to count as one of the face-to-face physician visits
  • Incorporating certain data items located in the Quality Indicators section of the IRF patient assessment index into the IRF case-mix classification system and to use these data items to assign patients into a case-mix group for payment purposes
  • Reducing the number of measures IRFs are required to report in the IRF quality reporting

IRF claims have seen increased scrutiny recently. In March, an audit showed Memorial University Medical Center, a hospital in Savannah, Georgia, received $444,458 in IRF overpayments due to claims that did not meet CMS’ documentation or medical necessity requirements.