AAPM&R Makes Progress in Addressing High IRF Error Rate Found by OIG

May 30, 2019

The Academy continues to fight the recommendations made in the October 2018 Office of Inspector General (OIG) report, Many Inpatient Rehabilitation Facility Stays Did Not Meet Medicare Coverage and Documentation Requirements. As a refresher, the report found an 84% error rate in claims submitted by inpatient rehabilitation hospitals and units (IRFs) in the year 2013 and recommended additional auditing of IRF claims and a demonstration project to impose prior authorization in the fee-for-service Medicare program for IRF patients.

AAPM&R partnered with the American Medical Rehabilitation Providers Association and the Federation of American Hospitals to respond to this report. Since October, the 3 organizations have met with front-line Congressional staff, senior leaders within the Centers for Medicare and Medicaid Services (CMS), and senior leaders at the OIG, with whom the group has put in place a process to pull a sample of claims from the report under the Freedom of Information Act. OIG has committed to reviewing these cases with experts in the IRF field to examine the clinical reasons for these denials. The goal is to attempt to have a meeting of the minds on IRF admission decisions that could assist in reducing the IRF error rate in coming years.

The Academy and its partner organizations also plan to meet with the Office of Management and Budget (OMB), the White House’s budget office, to further discuss our opposition to prior authorization in the fee-for-service Medicare program.