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 second document is a MLN booklet titled Inpatient Rehabilitation Facility (IRF) Reference Booklet. The booklet’s stated purpose is to provide education about common documentation errors, scenarios and solutions for IRF services, as identified by CMS’ medical review contractors. The booklet goes through most parts of the Medicare IRF coverage requirements, and analyses example scenarios to explain CMS’ standard for each requirement.

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.

Finally, 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.

If you have comments on these documents please email Jonathan Gold at jgold@amrpa.org.

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