tci Medicare Compliance & Reimbursement - 2005 Issue 4

Rehab: Sharpened Medical Necessity Focus Could Cripple IRFs

Newly enforced requirement comes as a surprise to many.Medicare's fiscal intermediaries have received their marching orders to clamp down on inpatient rehab facilities whose documentation doesn't prove medical necessity - and the aftermath could shutter 40 percent of IRFs.That's according to consultant Fran Fowler with Fowler Healthcare Affiliates in Atlanta, who has seen some IRFs receive a 60-80 percent denial rate on medical necessity, she tells MLR. The key to success: IRFs need to prove to FIs that their patients require therapy in an inpatient setting. The situation: When the Centers for Medicare & Medicaid Services released...

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