CMS seeks comment on proposed IRF claims review demonstration
The Centers for Medicare & Medicaid Services through Feb. 16 on a proposed Review Choice demonstration for inpatient rehabilitation facilities, which seeks to improve methods to investigate and prosecute Medicare fraud. All IRFs in the initial target states of Alabama, Pennsylvania, Texas and Colorado, would be required to choose between either 100% pre-claim or post-payment review. The audits would focus on compliance with Medicare coverage and clinical documentation requirements and continue until CMS determined that at least 90% of claims were properly paid. CMS would have authority to expand the demonstration to additional states in the future. CMS said the also would include risk-based options to reward IRFs that demonstrate compliance with Medicare policies.