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Medicare Compliance & Reimbursement

Rehab:

CMS Clarifies CORF Coverage Rules

Published on Sun Nov 14, 2004

Here are the services that CMS will never cover in a CORF.

If you're receiving denials for services provided in a comprehensive outpatient rehabilitation facility, a recent Centers for Medicare & Medicaid Services program transmittal could shed some light on the reasons why.
 
CMS Transmittal 21 clarifies general CORF requirements, and what services Medicare will and will not cover in the CORF setting. Among the highlights are:

 
  • Medicare does not cover any treatments involving exercises that do not require the "skilled services of therapists or other professional rehabilitation practitioners."

     
  • A CORF need not provide home evaluations, physical therapy, occupational therapy and speech-language pathology services on-site.
     
    In fact, a CORF may provide PT, OT and SLP services in any appropriate setting.
     
    In other rehab news, the HHS Office of Inspector General says CMS is paying far too many Part B therapy claims. The OIG makes that charge in the recently released Red Book, which is an annual compendium of cost-saving recommendations. In fact, Medicare has been shelling out about $97 million too much annually, according to the OIG's findings.
     
    "CMS should instruct fiscal intermediaries to conduct focused medical reviews of therapy payments and encourage them to educate providers about documentation requirements," the OIG says.

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