The agency said it will pay 100% of the net payable claims amount in certain cases, drawing praise from stakeholders.
After two years of payment negotiations between inpatient rehabilitation facilitaties (IRF) and the government, the Centers for Medicare & Medicaid Services announced a voluntary settlement offer Tuesday to IRFs with appeals pending.
Facilities that filed appeals at the Medicare Appeals Council (MAC) by August 31, 2018, that are eligible for further appeal will be able to settle their appeals with CMS paying 69% of the net payable amount for all claims connected to the pending IRF appeals, with some situations being offered an even higher payout, the agency said:
- The agency said it "will pay 100% of the net payable amount for all IRF appeals in which the claim was denied based solely on a threshold of therapy time not being met where the claim did not undergo more comprehensive review for medical necessity of the intensive rehabilitation therapy program based on the individual facts of the case"; and
- The agency said it "will pay 100% of the net payable amount for all IRF appeals in which the claim was denied solely because justification for group therapy was not documented in the medical record."
The settlement offer drew praise from the Federation of American Hospitals (FAH), which was involved in the negotiations, with FAH President and CEO Chip Kahn saying in a statement that the development "is a positive step forward."
"We appreciate partnering with CMS to achieve fair outcomes for the Medicare program, inpatient rehabilitation hospitals, and the patients who benefit from the unique intensive therapeutic care they provide," Kahn said.