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Policy: Meet Documentation Requirements To Safeguard Your Reimbursement


- Published on Mon, Jun 29, 2015

Tune in to the OIG Work Plan mid-year update.

On May 28, 2015, the Office of the Inspector General (OIG) published a mid-year update to its Fiscal Year FY 2015 Work Plan. This mid-year update removes items that have been completed, postponed, or canceled and includes new items that have been started after the 2015 Work Plan was published in October 2014.

Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) Requirements 

In 2016, the OIG plans to review compliance with various aspects of the IRF PPS, including the documentation required in support of the claims paid by Medicare, to determine whether IRF claims were paid in accordance with federal laws and regulations.

Background: IRFs provide rehabilitation for patients recovering from illness and surgery who require an inpatient hospital-based interdisciplinary rehabilitation program, supervised by a rehabilitation physician.

Effective for IRF discharges on or after January 1, 2010, IRFs must ensure that all documentation and coverage requirements set forth in 42 CFR § 412.622(a)(3), (4) and (5) are met to ensure that the IRF care is considered reasonable and necessary under the Social Security Act (the Act), § 1862(a)(1)(A).

Impact to you: If you belong to an IRF, it’s time to go through the above mentioned documentation and coverage requirements, and safeguard your revenue. Look forward to a summarized version of these requirements in a forthcoming issue. 



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