Inpatient Rehabilitation Facility Prospective Payment System Education Products Revised by CMS

In a recent report, the Office of Inspector General (OIG) determined that the Centers for Medicare & Medicaid Services (CMS) improperly paid for inpatient rehabilitation services to Medicare providers. Medical record documentation did not support that Inpatient Rehabilitation Facility (IRF) care was reasonable and necessary in accordance with Medicare coverage and documentation requirements, and did not comply with Medicare billing requirements.

In response to the educational recommendation in the OIG Report, CMS revised two Medicare Learning Network® (MLN) products. A national booklet titled, "Inpatient Rehabilitation Facility Prospective Payment System" was revised to educate IRF clinical and billing personnel on Medicare coverage and documentation requirements. CMS also collaborated with the Comprehensive Error Rate Testing (CERT) Medicare Administrative Contractor (MAC) A/B Task Force to revise an MLN web-based training (WBT) course titled, "Inpatient Rehabilitation Facilities (IRFs): Improving Documentation Positively Impacts CERT." Both products promote consistency for MAC outreach and education efforts for Medicare providers within their jurisdiction(s).

Additional CMS resources include:

Last Updated Sep 06, 2019