Review of Inpatient Rehabilitation Facility Claims Billed with Patient Status Code 05 Processed by National Government Services for Calendar Year 2007

摘要

Inpatient rehabilitation facilities (IRF) provide rehabilitation for patients who require a hospital level of care, including a relatively intense rehabilitation program and an interdisciplinary, coordinated team approach to improve their ability to function. Section 1886(j) of the Social Security Act (the Act) established a Medicare prospective payment system for IRFs. The Centers for Medicare & Medicaid Services (CMS), which administers the Medicare program, implemented the prospective payment system for cost-reporting periods beginning on or after January 1, 2002. The system provides for a predetermined, per-discharge payment. The IRF uses information from a patient assessment instrument to classify patients into distinct case-mix groups based on clinical characteristics and expected resource use.