Feds’ Inpatient Rehabilitation Proposal Hits Hurdles

Hospitals and physicians are opposing a proposal by the Centers for Medicare & Medicaid Services to further limit the instances patients can receive inpatient rehabilitation services.

In order to qualify as an inpatient rehabilitation facility, at least 60 percent of its admissions must be tied to one or more of 13 medical conditions, including spinal cord injury, amputation, major multiple trauma, hip fracture and brain injury.

The intent of the 60 percent rule is to limit IRF services, which are reimbursed at significantly higher rates, to patients who truly require the more intensive setting.

Providers that fall short of the threshold risk being paid acute-care rates, which can be as much as 49 percent lower, according to the Medicare Payment Advisory Commission.

Medicare payments to IRFs totaled about $6.46 billion in 2011, the last year a figure was released. There were 370,000 Medicare discharges from the facilities that year, down from 449,300 in 2005.

In recent years, the CMS has winnowed the array of diagnosis codes IRFs can cite when proving they are in compliance with the 60 percent rule. In last year’s payment rule, the agency removed 259 codes deemed outdated or too vague to indicate that a patient requires inpatient rehabilitation care.

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