CHA News Article

Office of Inspector General Reviews IRF Admissions, Documentation
Finds $5.7 billion in overpayments

The Office of Inspector General (OIG) of the U.S. Department of Health & Human Services has issued the attached report summarizing its review of inpatient rehabilitation facility (IRF) claims. OIG concludes that IRFs complied with all Medicare coverage and documentation requirements for only 45 of the 220 sampled stays, resulting in estimated overpayments to IRFs of $5.7 billion nationally. 

Based on its findings, OIG recommends that the Centers for Medicare & Medicaid Services conduct additional education for clinical and billing personnel; increase oversight activities; work with the Office of Medicare Hearings and Appeals to improve representation of Medicare coverage and documentation requirements at administrative law judge hearings; and re-evaluate the IRF payment system, including consideration of a demonstration project to require prior authorization for Part A IRF stays.