CMS Clarifies IRF Claim Processing


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.


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