CMS Posts 2020 IRF Proposed Rule

The focus on electronic health record implementation has turned to how to make use of the vast data stored within to improve revenue cycle operations (IRF).

Proposed rule calls amending regulations clarifying the determination as to whether a physician qualifies as a rehabilitation physician is made by the IRF.

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule for the inpatient rehabilitation

facility (IRF) prospective payment system for the fiscal year 2020. The proposal includes an estimated overall 2.5 percent increase factor that includes an IRF specific market basket estimate of 3 percent less a .5 percent productivity adjustment.

Additionally, CMS is proposing case mix group (CMG) revisions based on removal of Functional Independence Measure (FIM^tm) scoring and use of Quality Indicator data for classification of patients into CMG groups.  Of note, CMS elected to weight the scores for functional indicators in determining placement in a CMG.

Updated Related To Quality Measures

The proposed rule also includes the following:

• Two proposed additional Quality Measures both of which relate to Medication Reconciliation:
  • Transfer of Health Information to the Provider; and
  • Transfer of Health Information to the Patient.
• Proposed adoption of a number of standardized patient assessment data elements (SPADEs).
• These added data elements will assess cognitive function and mental status, special services, treatments and interventions, medical conditions and co-morbidities, impairments, and social determinants of health (race and ethnicity, preferred language and interpreter services, health literacy, transportation, or social isolation).
• Updates to the Discharge to Community IRF QRP measure
• Removal of the published list of compliant IRFs from the IRF QRP website
• Requirement to collect IRF-PAI data on all patients regardless of the patients’ payer

Additional Proposed Provisions

CMS is also proposing to amend the regulations to clarify that the determination as to whether a physician qualifies as a rehabilitation physician is made by the IRF.

For More Information: https://www.racmonitor.com/news-alert-cms-posts-2020-irf-proposed-rule