With little fanfare, last week the Centers for Medicare & Medicaid Services (CMS) announced another Review Choice Demonstration Project. Joining the ongoing Review Choice Demonstration for Home Health Services Project, CMS will require every admission to an Inpatient Rehabilitation Facility (IRF) in the state of Alabama to be reviewed, starting in July. Despite the name suggesting that IRFs have a choice about participation, this will be mandatory, but each IRF will have the choice to have their admissions reviewed either prior to payment or on a post-payment basis.
CMS is also doubling down on the choice concept; if an IRF “demonstrates compliance with Medicare rules” during the first six months of audits, they will have the choice of continuing with 100-percent claim review, either pre- or post-payment, or selecting to have a random selection of their admissions audited pre-payment.
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Dr. Ronald Hirsch is Vice President of the Regulations and Education Group at R1 RCM Inc. Dr. Hirsch was a general internist and HIV specialist and practiced at Signature Medical Associates, a multispecialty practice located in Elgin, IL. He was Medical Director of Case Management at Sherman Hospital in Elgin, IL from 2006 to 2012, where he was Chairman of the Medical Records Committee from 1995 to 2012, and also served on the Medical Executive Committee. Dr. Hirsch is certified in Health Care Quality and Management by the American Board of Quality Assurance and Utilization Review Physicians, certified in Revenue Integrity by the National Association of Healthcare Revenue Integrity, and on the Advisory Board of the American College of Physician Advisors. He is on the editorial board of RACmonitor.com. He is the co-author of The Hospital Guide to Contemporary Utilization Review, with the third edition published in 2021.