“The Centers for Medicare & Medicaid Services (CMS) today announced it is seeking public comment on a new Review Choice Demonstration (RCD) for Inpatient Rehabilitation Facility (IRF) services. This demonstration develops improved methods for the identification, investigation, and prosecution of potential Medicare fraud. The demonstration would also help ensure the right payments are made at the right time for IRF services through either pre-claim or post-payment review; thus, protecting the Medicare Trust Fund from improper payments, reducing the number of Medicare appeals, and improving IRF compliance with Medicare program requirements.”
“’This demonstration is in line with CMS’s ongoing efforts to identify and prevent fraudulent billing, protect our Medicare program and safeguard taxpayer dollars,’ said CMS Administrator Seema Verma. ‘This new demonstration will ensure that patients receive the appropriate services for which they are covered for under Medicare and help sustain the Medicare Trust Fund.’”
“CMS plans to implement the demonstration in Alabama, and then expand to Pennsylvania, Texas, and California. These states were selected due to particularly high rates of improper payments for IRF services. The demonstration would begin in 2021.”
“An IRF provides more intensive rehabilitation medical care than a skilled nursing facility or home-based rehabilitation services. CMS chose IRFs for a demonstration due to the potential for high rates of improper payments in these facilities, which could lead to potential fraud, waste and abuse. In fiscal year 2020, the estimated amount of improper payments to IRFs under Medicare fee-for-service was more than $2.4 billion, or 30.8%, the second-largest amount among Medicare service areas…”
“The demonstration would incorporate flexibility and choice for IRFs, as well as risk-based options to reward IRFs who demonstrate compliance with Medicare IRF policies. Under the demonstration, IRFs participating in the demonstration would have an initial choice between pre-claim review and post-payment review to demonstrate compliance with Medicare program policies…” Read the full press release here.
Source: CMS Solicits Public Comment for a New Demonstration to Offer Inpatient Rehabilitation Providers Flexibilities and Reduce Medicare Fraud – December 14, 2020. CMS.
