New IRF Coverage Requirement Documents

CMS Issues New IRF Coverage Requirement Documents

CMS recently announced a number of new documents pertaining to IRF coverage requirements. The first is a Medicare Learning Network (MLN) article titled Inpatient Rehabilitation Facility (IRF) Medical Review Changes. This article provides information about new instructions that CMS recently issued to Medicare review contractors regarding the standards to use when reviewing claims for compliance with the intensity of therapy requirements for IRF claims.

The next document is standard IRF denial reason codes and statements. CMS states they created these standardized denial reasons and codes because different contractors often used different codes and phrasing, and that by standardizing the codes CMS would lessen the burden on providers and allow for a better understanding of the reason for denial.

CMS has also compiled all coverage requirement clarifications issued by CMS pertaining to IRF coverage requirements into one document. This document does not contain any new clarifications, but just compiles previously issued clarifications in to one document. The document can be found at this link.

Updated as of Febuary 1, 2018
Finally, CMS had also posted an MLN booklet titled Inpatient Rehabilitation Facility (IRF) Reference Booklet. The booklet went through most parts of the Medicare IRF coverage requirements, and analyzed example scenarios to explain CMS' standard for each requirement. However, after AMRPA staff met with CMS and brought It to their attention serveral errors and misinterpretations of Medicare policy in the booklet, CMS withdrew the booklet and "does not recommend that anybody use this document."

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