tci Medicare Compliance & Reimbursement - 2005 Issue 25

Rehab: Feds Take Umbrage With IRF Upcoding

CMS hints that IRFs are upcoding on a regular basis.The Centers for Medicare and Medicaid Services anticipates aggregate payments to inpatient rehab facilities to increase, but CMS also proposed a 1.9 percent standard payment amount reduction based on evidence that "coding changes" caused unnecessary IRF payment increases.  In the 2006 proposed inpatient rehab facility payment rule published in the Federal Register, CMS dances around an outright accusation of upcoding, stating only once that "upcoding for higher reimbursement may be a factor," but its view is clear in this proposed rule. And while upcoding charges...

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