Health Information Management

Healthcare News: CMS transmittal outlines new coverage requirements for IRF services

JustCoding News: Outpatient, November 4, 2009

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On October 23, CMS issued Transmittal 112 in the Medicare Benefit Policy Manual, which describes new instructions for coverage for services provided in inpatient rehabilitation facilities (IRF). The new coverage policies take effect for IRF discharges occurring on or after January 1, 2010.

CMS made the changes pursuant to recent regulatory changes that can be found in 42 CFR 412.622 (74 FR 39762 (August 7, 2009)).

The Transmittal includes guidance for the following:

  • IRF services
  • Documentation requirements:
    • Preadmission screening
    • Post-admission physician evaluation
    • Individualized overall plan of care
    • Admission orders
    • IRF patient assessment instrument forms
  • IRF medical necessity criteria
    • Multiple therapy disciplines
    • Intensive level of rehabilitation services
    • Ability to actively participate in inpatient rehabilitation therapy program
    • Physician supervision
    • Interdisciplinary team approach to the delivery of care
  • Definition of measurable improvement

In related news, CMS will host a national provider conference call November 12 from 2 p.m. to 4 p.m. EST about IRF prospective payment system coverage requirements based on the fiscal year 2010 final rule. You must register to attend this call, which will include a question and answer session. After the call, CMS plans to post Q&As from this call, as appropriate, to the IRF Coverage Requirements Web site.

CMS will close registration for this call at 2 p.m. EST November 11, or when it has filled the available space.

CMS plans to post a PowerPoint slide presentation at least one day prior to the call on the IRF PPS Coverage Web page so that attendees can follow along with the presenter.

Editor's note: Interested in learning more about recovery audit contractors and inpatient rehab facilities? Tanja Twist, MBA/HCM, Nancy Beckley, MS, MBA, CHC, and Marion Watson, PT, MBA, will discuss these coverage changes as well as where to focus your own internal audits and how to strengthen your appeals during a November 18 HCPro audio conference, “RACs and Inpatient Rehab: Understand the Top Demo Targets to Survive Audits.” To learn more or to purchase, go to the HCMarketplace Web site.

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