Medicare Compliance & Reimbursement

GAO greenlights IRFs' 75-percent compliance threshold.

The government has decided that rehab providers can receive Medicare payments on services for patients with the additional qualifying medical conditions listed in the May 7, 2004 final rule.

The Government Accountability Office approved the Centers for Medicare and Medicaid Services' implementation of its final rule that allows a four-year transition period to increase inpatient rehabilitation facilities' compliance thresholds from 50 to 75 percent, CMS announced June 21.

The GAO was skeptical of the final rule's additional qualifying conditions, however. "There was general agreement among all the groups of experts interviewed that condition alone is insufficient for identifying appropriate types of patients for inpatient rehabilitation, since within any condition only a subgroup of patients require the level of services of an IRF," the GAO concluded from its April 2005 report. CMS should consider the functional status in addition to the condition, the GAO says.

CMS claims it has already taken steps to improve IRF classification processes and that its classification criteria is consistent with the GAO's recommendations, however.

CMS expects IRFs' compliance threshold to gradually reach 75 percent for cost reporting periods beginning on or after July 1, 2007. CMS publish ed its notice in the June 24 Federal Register.