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Medicare Compliance & Reimbursement

Rehab:

IRFs Need To Get Up To Speed On PPS Regs

Published on Thu Aug 26, 2004

Here are the billing mistakes the OIG is looking for.

 If inpatient rehab facilities want to avoid paying up the next time auditors pay them a visit, they'll need to brush up on these prospective payment system regulations:
     
 
  • Transfers. According to the Centers for Medicare & Medicaid Services, IRFs transferring patients to acute or post-acute care facilities will have their discharge payment adjusted to a per-diem payment if the IRF stay is less than the average length of stay for non-transfer cases in the same case mix group. IRFs must use specific patient status codes to identify claims subject to the transfer regulation.
         
     
  • Interrupted Stays. IRFs will receive one discharge payment for an interrupted stay based on the case mix group classification determined by the patient assessment performed at admission. When a Medicare inpatient is discharged from an IRF and returns to the same IRF within three days, the interrupted stay begins with the day of discharge from the IRF and ends on midnight of the third day.
     
    Overstepping these regulations on 49 claims recently stuck Springfield, MA-based Weldon Rehabilitation Hospital with a $202,872 overpayment. According to the July 23 report, "Review of Medicare Inpatient Rehabilitation Facility Prospective Payments at Weldon Rehabilitation Hospital for Fiscal Year 2003" (A-01-04-00504), the HHS Office of Inspector General found the facility had not used proper patient status codes to identify claims subject to patient transfer regulations. Weldon was also nailed for an "isolated instance" where a patient was discharged and readmitted two days later for a several-week stay. The interrupted stay was incorrectly billed as two separate IRF claims rather than the single payment.
     
    To read the report, go to     http://www.oig.hhs.gov/oas/reports/region1/10400504.pdf.

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