Inpatient Rehabilitation Facility (IRF) - California only - JE Part A
Inpatient Rehabilitation Facility (IRF) - California only
Starting May 1, 2026, CMS will launch the Review Choice Demonstration (RCD) for Inpatient Rehabilitation Facility (IRF) services in California. California IRF providers can choose either 100% pre-claim review or 100% post-payment review during the selection period, March 16, 2026-April 14, 2026. IRF providers are encouraged to utilize the Noridian Medicare Portal to select a review choice. An IRF's choice selection is made at the Provider Transaction Access Number (PTAN) level.
This demonstration applies to IRFs that provide rehabilitation services, are enrolled in the Medicare Fee-for-Service (FFS) program, submit claims to Jurisdiction E, and render services in the state of California. The initiative is designed to reduce administrative burden for IRFs that consistently meet Medicare requirements while offering facilities the flexibility to choose their preferred review option.
Demonstration Overview
Initial Review Options
IRFs can initially choose one of two review options:
- Choice 1: Pre-Claim Review
- Choice 2: Post-Payment Review (default if no selection is made)
Compliance determines future choices. Every six months, CMS calculates an IRF's affirmation or approval rate (minimum 10 requests/claims).
Subsequent Review Options
If the target rate is met, the IRF may choose from:
- Choice 1: Pre-Claim Review
- The IRF may begin or continue participating in pre-claim review for a 6-month period
- Choice 3: Selective Post-Payment Review (default if no selection is made)
- The IRF submits claims as usual
- Every six months, the MAC conducts a post-payment review of a statistically valid random sample based on the prior six months of claim volume
- Choice 4: Spot Check Review
- The MAC reviews a random 5% sample of submitted claims for prepayment review, based on the prior six months of claim volume
If the target is not met or 10 requests/claims have not been submitted, the IRF must select from the initial two choices.
Target affirmation rates:
- First review cycle: 80%
- Second review cycle: 85%
- Third review cycle: 90%
New IRFs will follow their state's current review cycle. IRFs under Unified Program Integrity Contractor (UPIC) review are not eligible for this demonstration. However, all IRFs are encouraged to make a selection. For UPIC-related questions, contact the UPIC directly.
