Medicare Compliance & Reimbursement

Controversial 75 percent rule still unsettled. Inpatient rehabilitation facilities will get a 3.2-percent raise in 2004, the Centers for Medicare & Medicaid Services revealed in an Aug. 1 payment rule. But the fate of the much-maligned 75-percent rule still remains up in the air. The 75-percent rule requires rehab hospitals to show that at least three-quarters of their inpatient population over the most recent 12-month cost reporting period required "intensive rehabilitation services for 10 serious medical conditions," such as stroke, amputations and brain injuries. Providers have protested that the rule is so strict - not to mention outdated and inconsistent -that virtually no facilities would qualify for the IRF prospective payment system. A coalition of providers this summer called for the rule's repeal. CMS did not, as many hoped, offer a solution in its Aug. 1 payment rule. However, the agency promised to amend the 75-percent rule promptly -and stated that enforcement of the provision would be suspended until its new policy on the subject went into effect.

"After three months of discussion with the rehab community, we believe that we can articulate an appropriate compromise on the 75-percent rule," promises CMS Administrator Tom Scully. To see the rule, go to http://www.access.gpo.gov/su_docs/fedreg/a030801c.html. Lesson Learned: Rehab facilities need to track the evolution of the 75-percent rule closely - how the cards fall will have a huge impact on their bottom line.