On March 27, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for Inpatient Rehabilitation Facilities (IRFs) that would update payment policies for the 2025 fiscal year (FY) and add four new items as Standardized Patient Assessment Data elements, modify an additional item, and remove the Admission Class item from the IRF-PAI (Patient Assessment Instrument).
Additionally, CMS is proposing a three-year phaseout of the rural adjustment for IRFs changing from rural to urban, as a result of the proposed revised Office of Management and Budget (OMB) market area delineations.
The proposed rule, to be formally published in the Code of Federal Regulations (CFR) as of March 29, also requests information related to IRF QRP (Quality Reporting Program) quality measures and concepts, as well as the IRF QRP Star Rating system.
The major components are addressed below:
The proposed policy changes, consistent with prior years, include:
Following standard methodology, CMS has recommended a $255 million increase in IRF payments over the last FY. CMS also proposes an update to IRF payment by 2.8 percent, based on the proposed IRF market basket update of 3.2 percent, less a proposed 0.4 percent productivity adjustment. The result is a proposed Standard Payment Rate for FY 2025 of $18,872.
Table 10 of the proposed rule illustrates the calculations:
CMS is also proposing to collect four new items as part of the Standardized Patient Assessment under the Social Determinants of Health (SDoH) category. These items would be added to FY 2028 IRF QRP and include one item related to living situations, two items related to food, and a final item related to utilities.
The proposed Living Situation item asks:
“What is your living situation today?” The proposed response options are: (1) I have a steady place to live; (2) I have a place to live today, but I am worried about losing it in the future; (3) I do not have a steady place to live; (4) Patient declines to respond; and (5) Patient unable to respond.
The proposed Food items are:
“Within the past 12 months, were you worried that your food would run out before you got money to buy more?”
“Within the past 12 months, did the food you bought just not last, and you didn’t have money to get more?”
The proposed response options for both of these items are: (1) Often true; (2) Sometimes true; (3) Never True; (4) Patient declines to respond; and (5) Patient unable to respond.
The proposed Utilities item asks:
“In the past 12 months, has the electric, gas, oil, or water company threatened to shut off services in your home?” The proposed response options are: (1) Yes; (2) No; (3) Already shut off; (4) Patient declines to respond; and (5) Patient unable to respond.
Additionally, CMS proposes to modify the Transportation Item to align it with the Accountable Health Communities (AHC) Health-Related Social Needs (HRSN) Screening Tool for SDoH. The current question in Item A1250, Transportation, currently collected in the IRF-PAI asks: “Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?” This item would be modified to revise the lookback period to include “in the last 12 months” and would simplify the response options to (1) Yes; (2) No; (3) Patient declines to respond; and (4) Patient unable to respond.
This modification would also be added to the FY 2028 IRF QRP data.
As admission class is not currently used in any calculations of quality measures, so CMS proposes to remove the item from the IRF-PAI, effective Oct. 1, 2026.
In the proposed rule, CMS also requests feedback on two areas:
Readers can access the associated CMS Fact Sheet here.
Literature is ripe with classic phrases that seem timelessly apropos. For example, take the partial federal government shutdown. For days, the phrase repeated in the
While underdosing is no longer a new concept in coding it remains a common area of confusion. Underdosing is when a patient takes less of
Please log in to your account to comment on this article.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
Copyright © 2024 ICD10monitor. Powered by MedLearn Media.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
