News & Analysis as of

Medicare Inpatient Rehab Facilities

King & Spalding

OIG Audit Finds Medicare Overpaid Hospitals an Estimated $79 Million for Enrollees Who Had Received Mechanical Ventilation

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On August 12, 2024, OIG announced the results of an audit of payments made to hospitals for inpatient claims with the Medicare Severity Diagnosis-Related Groups (MS-DRGs) that require ninety-six hours of consecutive...more

Alston & Bird

Health Care Week in Review: CMS Finalizes FY 2025 Payment Rules for Inpatient Hospitals, Inpatient Rehab Facilities, Inpatient...

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Below is Alston & Bird’s Health Care Week in Review, which provides a synopsis of the latest news in health care regulations, notices, and guidance; federal legislation and congressional committee action; reports, studies,...more

Warner Norcross + Judd

Medicare Open Enrollment: Making Smart Choices for Rehabilitation Stays

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Medicare’s open enrollment period is just a few weeks away, and it is not too early to start thinking about your coverage options. One benefit area that Medicare recipients often overlook is long term rehabilitation coverage....more

King & Spalding

CMS Issues FY 2024 Final Rule Updating Medicare Payment and Policies for Inpatient Rehabilitation Facilities

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On July 27, 2023, CMS issued a final rule updating Medicare payments and policies under the Inpatient Rehabilitation Facility (IRF) Prospective Payment System and the IRF Quality Reporting Program for FY 2024 (Final IRF...more

King & Spalding

CMS Review Choice Demonstration for Inpatient Rehabilitation Facility Services Beginning in August 2023

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On June 27, 2023, CMS hosted a Special Open Door Forum regarding its Review Choice Demonstration program for Inpatient Rehabilitation Facility Services (IRFs). CMS has stated that the Medicare IRF benefit continues to...more

King & Spalding

CMS Issues Proposed Rules to Update Medicare Payment Rates and Policies for Skilled Nursing Facilities and Inpatient Psychiatric...

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On April 4, 2023, CMS issued proposed rules for Fiscal Year (FY) 2024 to update Medicare payment policies for skilled nursing facilities (SNFs) and inpatient psychiatric facilities (IPFs). CMS notes these rules are intended...more

Stevens & Lee

FY 2024 Proposed Medicare Reimbursement Changes for Certain Nursing and Inpatient Facilities

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On April 3-4, Centers for Medicare & Medicaid Services (CMS) issued a number of proposed rules that would materially impact reimbursement rates for skilled nursing facilities (SNFs), inpatient psychiatric facilities (IPFs)...more

King & Spalding

OIG Adds New Nationwide Inpatient Rehabilitation Facility Audit to Work Plan

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This month, OIG updated its work plan to include a new Inpatient Rehabilitation Facility (IRF) Nationwide Audit. In explaining the new workstream, OIG cited high IRF error rates in other reviews and plans to determine whether...more

King & Spalding

CMS Issues Three Payment Rules for FY 2023

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On July 27, 2022, CMS issued final rules for FY 2023 in its yearly update to Medicare payment policies and rates under the Inpatient Rehabilitation Facilities (IRFs) prospective payment system (PPS) and the Inpatient...more

Stevens & Lee

Medicare Boosts Payments for Hospices, Rehab Facilities and Psychiatric Facilities

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The Biden administration recently released three final rules that provide for an aggregate $1.19 billion increase in Medicare payments in fiscal year 2023 for hospices, rehabilitation facilities, and psychiatric facilities. ...more

King & Spalding

CMS Issues Final Rule Affecting Home Health, Hospice, Inpatient Rehabilitation Facilities, and Long-Term Care Facilities for CY...

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On November 2, 2021, CMS put on display its final rule that, among other things, updates the home health and home infusion therapy services payment rates for calendar year (CY) 2022; makes significant changes to the provider...more

Fox Rothschild LLP

The Importance Of Updating Compliance Programs For Skilled Nursing, Assisted Living And Other Residential Care Facilities

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Skilled Nursing Facilities in particular and to a lesser extent other types of Residential Care Facilities, including Assisted Living Facilities and Behavioral Health Facilities, have always been under the government’s...more

Sheppard Mullin Richter & Hampton LLP

The Scope-of-Practice Debate Takes Center Stage: The 2021 Medicare Inpatient Rehabilitation Facility Prospective Payment System...

As noted in our March 31, 2020 blog article, “Strategies in Responding to COVID-19: Expanding Scope of Practice to Increase Patient Access to Healthcare” and in our May 8, 2020 blog article, “COVID-19: Medical Liability for...more

Manatt, Phelps & Phillips, LLP

[Webinar] Long-Term Care in the Time of COVID-19: Part Two - June 16th, 1:00 pm - 2:00 pm ET

Examine the Immediate Issues and Opportunities Facing Long-Term Care Providers—and Look Ahead at How to Build a Stronger Future—at a New Webinar Series From Manatt Health. The nation’s nursing homes, assisted-living...more

Manatt, Phelps & Phillips, LLP

[Webinar] Long-Term Care in the Time of COVID-19: Part One - June 8th, 1:00 pm - 2:00 pm ET

Caring for Recipients, Protecting the Workforce and Supporting Provider Sustainability - Examine the Immediate Issues and Opportunities Facing Long-Term Care Providers—and Look Ahead at How to Build a Stronger Future—at a...more

King & Spalding

CMS Issues New Round of Waivers and Rule Changes In Response to COVID-19

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Last week CMS issued a new round of regulatory waivers and rule changes in response to the COVID-19 public health emergency, including its Interim Final Rule with comment period, CMS-5531-IFC. The key changes relax certain...more

Arnall Golden Gregory LLP

Good News for Medicare Providers as CMS Expands Settlement Conference Facilitation and Introduces New Initiative for IRFs

The Centers for Medicare and Medicaid Services (CMS) made a number of recent changes to expand the Settlement Conference Facilitation (SCF) process for providers and suppliers mired in the backlog of appeals at the...more

Baker Donelson

CMS Offers 100 Percent or 69 Percent Recovery Settlement Option for Backlogged Medicare IRF Claim Appeals

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In the wake of its recent efforts to settle claims (see the 2014 initial hospital inpatient settlement and the 2016 second-round wave), in the heavily backlogged Medicare administrative appeals system, CMS has introduced a...more

King & Spalding

CMS Announces Settlement Program for Inpatient Rehabilitation Facility Appeals

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On June 17, 2019, CMS announced a voluntary settlement program for Inpatient Rehabilitation Facility (IRF) appeals pending at the Medicare Administrative Contractor (MAC), the Qualified Independent Contractor, the Office of...more

Chambliss, Bahner & Stophel, P.C.

Medicare's Different Treatment of the Two Main Post-Hospital Care Options

Hospital patients who need additional care after being discharged from the hospital are usually sent to either an inpatient rehabilitation facility (IRF) or a skilled nursing facility (SNF). Although these facilities may look...more

Manatt, Phelps & Phillips, LLP

Assessing the Regulatory Burden on Inpatient Psychiatric Facilities - April 2019

Editor’s Note: Inpatient psychiatric facilities operate under a heavy burden of federal regulatory requirements. In a new report commissioned by the National Association of Behavioral Health (NABH), summarized below, Manatt...more

King & Spalding

New Medicare Policy and Payment Changes Proposed for Inpatient Rehabilitation Facilities

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CMS released the Fiscal Year 2020 proposed rule (the Proposed Rule) outlining new Medicare policy and payment changes for inpatient rehabilitation facilities (IRFs) last Wednesday. The Proposed Rule proposes updating IRF...more

Manatt, Phelps & Phillips, LLP

The High Cost of Compliance: Assessing the Regulatory Burden on Inpatient Psychiatric Facilities

Inpatient psychiatric facilities operate under a heavy burden of federal regulatory requirements. The National Association for Behavioral Healthcare (NABH) commissioned Manatt Health to assess the burdens that certain federal...more

King & Spalding

OIG Hospital Compliance Program Audit Claims $22 Million in Extrapolated Overpayments

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A recent report issued by OIG finding an Indiana community hospital owed over $22 million in extrapolated overpayments carries some important lessons for hospitals audited under OIG’s hospital compliance program. As described...more

Baker Donelson

CMS Refines Proposed Changes to SNF Reimbursement with Patient-Driven Payment Model

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On May 8, 2018, in its FY2019 SNF PPS Proposed Rule, CMS proposed a new case mix classification system that drives Medicare reimbursement for SNF inpatient services. The new system would go into effect on October 1, 2019. CMS...more

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