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Inpatient Rehabilitation Facility Nationwide Audit

Inpatient rehabilitation facilities (IRFs) provide intensive inpatient rehabilitation therapy for patients who have complex nursing, medical management, and rehabilitation needs that require hospital-level treatment in an inpatient environment. For an IRF claim to be considered reasonable and necessary, IRFs must meet certain coverage and documentation requirements. Our prior OIG audits have identified billions of dollars in overpayments for IRF claims. We plan to determine whether there are areas where CMS can clarify Medicare IRF claims payment criteria. In addition, we will follow up on recommendations from our prior IRF audit, A-01-15-00500.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
September 2022 Centers for Medicare and Medicaid Services Inpatient Rehabilitation Facility Nationwide Audit Office of Audit Services WA-22-0014 (W-00-22-35891) 2024