Medicare Makes Major Changes to Coverage Requirements for Inpatient Rehabilitation Services

Requirements for Medicare coverage of Inpatient Rehabilitation Services will undergo a number of changes, effective January 1, 2010. Centers for Medicare and Medicaid Services (CMS) released a transmittal on October 23, 2009 detailing these changes, which include several new requirements for the patient admission process and ongoing recordkeeping. Admission will only be considered “reasonable and necessary” by CMS if the new procedures are followed.

The new mandatory requirements are significant, and include preadmission screening, post-admission physician evaluation, individualized plans of care, and a definition of measurable improvement, along with many other requirements.

As hospitals are gearing up for the permanent RAC program activity, it will be important for IRFs to comply with the new IRF requirements.

These changes are reflected in modifications to Chapter 2, Section 110 of the Medicare Benefit Policy Manual.

For more information on compliance with Medicare requirements, contact Abby Pendleton, Esq. or Jessica Gustafson, Esq. at (248) 996-8510.