Policy Changes for Medicare Inpatient Rehabilitation
Facilities
Proposed
Fiscal Year 2016 Payment and Policy Changes for Medicare Inpatient
Rehabilitation Facilities (CMS-1624-P)
On April
23, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a
proposed rule outlining proposed fiscal year (FY) 2016 Medicare payment
policies and rates for the Inpatient Rehabilitation Facility Prospective
Payment System (IRF PPS) and the IRF Quality Reporting Program (IRF QRP). The FY 2016 proposals are summarized below.
Proposed Changes to IRF payment policies and rates:
Changes
to the payment rates under the IRF PPS.
CMS is proposing to update the IRF PPS payments for FY 2016 to reflect
an estimated 1.9 percent increase factor (reflecting a new IRF-specific market
basket estimate of 2.7 percent, reduced by a 0.6 percentage point multi-factor
productivity adjustment and a 0.2 percentage point reduction required by law).
CMS is proposing that if more recent data are subsequently available (for
example, a more recent estimate of the market basket or multifactor
productivity adjustment) we would use such data, to determine the FY 2016
update in the final rule. An additional 0.2 percent decrease to aggregate
payments due to updating the outlier threshold results in an overall update of
1.7 percent (or $130 million), relative to payments in FY 2015.
No
changes to the facility-level adjustments. As stated in the FY 2015 IRF PPS
final rule (79 FR 45872, 45882 through 45883), CMS froze the facility-level
adjustment factors at the FY 2014 levels for FY 2015 and all subsequent years,
unless and until we propose to update them again through future notice and
comment rulemaking. For FY 2016, CMS will continue to hold the facility-level
adjustment factors at the FY 2014 levels as we continue to monitor the most
current IRF claims data available to assess the effects of the FY 2014 changes.
ICD-10-CM Conversion.
In the FY 2015 IRF PPS final rule (79 FR
45872), CMS finalized conversions from the International Classification of
Diseases, 9th Revision, Clinical Modification (ICD-9-CM) to the International
Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)
for the IRF PPS, which will be effective when ICD-10-CM becomes the required
medical data code set for use on Medicare claims and IRF‑PAI submissions. CMS reminds
providers of IRF services that the implementation date for ICD-10-CM is October
1, 2015.
Be aware of all upcoming changes.
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