What’s happening: The Centers for Medicare & Medicaid Services (CMS) has posted to its website a report on the ongoing Review Choice Demonstration for Inpatient Rehabilitation Services (IRF RCD) — a program currently in Alabama and Pennsylvania that will expand to California in the future, though a specific time frame has not yet been established.
What else to know: Based on IRF RCD results to date, CMS has released a Helpful Hints document that could assist California providers, as it includes reasons a claim might not be affirmed, as well as best practices that may help avoid non-affirmations.
The current report summarizes quarterly review results for fiscal year 2024 (including the number or reviews), approval and provisional affirmation rates, and the most frequently noted reasons for non-affirmation. Overall approval/affirmation rates ranged from a low of 82% to a high of 94%.
