CMS Clarifies IRF Claim Processing

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CMS published revisions to the inpatient rehabilitation facility (IRF) section of the Medicare Claims Processing Manual (Chapter 3, Section 140 of Pub. 100-04) in Transmittal 2638 [PDF] on January 18, 2013. According to CMS, the changes are intended only to clarify existing IRF payment policies. The changes address the following issues:

  • IRF classification requirements
  • Criteria for inpatient rehabilitation units
  • Verification process used to determine if IRF meets classification criteria
  • New IRFs
  • Changes in the status of an IRF unit
  • New IRF beds
  • Change of ownership or leasing
  • IRF mergers
  • Full time equivalent resident cap
  • Outlier payments

The related provider education article (MLN Matters Number: MM8127) can be accessed here [PDF]. The effective date of the revised manual provisions is April 22, 2013.

 


DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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