Nationwide Review of Inpatient Rehabilitation Facilities Transmission of Patient Assessment Instruments for Calendar Years 2006 and 2007

摘要

Under the prospective payment system for inpatient rehabilitation facilities (IRF), the Centers for Medicare & Medicaid Services (CMS) establishes a prospective payment rate for each of 92 distinct case-mix groups. Medicare Part A fiscal intermediaries, under contract with CMS, use the Fiscal Intermediary Shared System (FISS) to process and pay claims submitted by IRFs. To administer the prospective payment system, CMS requires IRFs to electronically transmit a patient assessment instrument for each IRF stay to CMSs National Assessment Collection Database (the Database), which the Iowa Foundation for Medical Care (the Foundation) maintains. Each IRF must report the date that it transmitted the instrument to the Database on the claim that it submits to the fiscal intermediary. If an IRF transmits the instrument more than 27 calendar days from (and including) the beneficiarys discharge date, the IRFs payment rate for the applicable case-mix group should be reduced by 25 percent. Our audit covered 10,338 claims totaling $166 million that were at high risk of having been overpaid because IRFs had transmitted the patient assessment instruments to the Database after the 27-day deadline. Our objective was to determine whether IRFs received reduced case-mix-group payments for claims with patient assessment instruments that were transmitted to the Database more than 27 days after the beneficiaries discharges.