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Inpatient Rehabilitation Facility Payment System Requirements

Inpatient rehabilitation facilities (IRFs) provide rehabilitation for patients recovering from illness and surgery who require an inpatient hospital-based interdisciplinary rehabilitation program, supervised by a rehabilitation physician.  Effective for discharges on or after January 1, 2010, specific medical record documentation, at the time of IRF admission, must support a reasonable expectation that the patient needs multiple intensive therapies, one of which must be physical or occupational therapy; is able to actively participate and demonstrate measurable improvement; and requires supervision by a rehabilitation physician to assess and modify the course of treatment as needed to maximize the benefit from the rehabilitation process. Our prior reviews of individual IRFs have identified substantial Medicare overpayments. We will determine whether IRFs nationwide billed claims in compliance with Medicare documentation and coverage requirements.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
Nov-16 Centers for Medicare & Medicaid Services Inpatient Rehabilitation Facility Payment System Requirements Office of Audit Services W-00-15-35730 2018

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