Eli's Rehab Report
Cahaba Review Reveals 95% Error Rate
Fiscal intermediary Cahaba GBA released its third-quarter results of an inpatient rehabilitation facility services review--and lower extremity joint replacement case mix groups have major room for improvement.
A review targeting bill type 11X, revenue code 0024 and CMGs A0801-A0802 (replacement of lower extremity joint) revealed a 95.52 percent error rate of these rehabilitation services between April 1 and June 30, according to Cahaba.
Of 351 claims reviewed, only 14 were approved, leaving $3,906,130.76 of denied charges.
Noting that the majority of denials resulted from insufficient medical justification for the IRF services, Cahaba points its providers to Local Coverage Determination (LCD) L15198 - Inpatient Rehabilitation, which outlines specific documentation requirements to support medical necessity.
The FI also noted that it denied 36 claims due to untimely record submission, resulting in 56,900 denials.
Take note: Cahaba Alabama Medical Review Part A will continue the 100 percent widespread targeted pre-pay review of all IRFs (bill type 11X) with revenue code 0024 (all inclusive ancillary) billing CMG A0801 and CMG A0802.
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