The anticipated issue date for the new audit is the 2024 fiscal year.
Citing “consistently high error rates,” federal officials announced this week that they will be conducting a nationwide audit of Inpatient Rehabilitation Facilities (IRFs).
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) on Tuesday added the item to its Work Plan, noting that is seeking “more information from IRF stakeholders” in order to ascertain which claims such providers feel should be covered by Medicare.
“We plan to determine whether there are areas in which CMS (the Centers for Medicare & Medicaid Services) can clarify Medicare IRF claims payment criteria,” the posting read. “In addition, we will follow up on recommendations from our prior IRF audit. We believe data and input from IRF stakeholders are critical to identifying any specific areas that might require clarification and will result in more meaningful recommendations and a greater positive impact on the program.”
That prior nationwide audit of IRF claims, issued in September 2018, found that medical record documentation for 175 of 220 sampled IRF stays did not support that care provided was “reasonable and necessary, in accordance with Medicare requirements,” officials noted, adding that Hospital Compliance audits also “frequently” include IRF claims and have found similarly high error rates (as have Comprehensive Error Rate Testing, or CERT, audits).
Officials noted that IRF stakeholders responded to the findings by asserting that Medicare audit contractors and the OIG itself misconstrued IRF coverage regulations – and the new nationwide audit, they added, is expected to determine the degree to which that may be the case.
IRFs, which number about 1,150 nationwide, provide intensive rehabilitation services to patients after illness, injury, or surgery; many such patients also have complex nursing, medical management, and rehabilitation needs that require hospital-level treatment in an inpatient environment. During the 2021 fiscal year, OIG noted, Medicare paid approximately $8.7 billion for 373,000 IRF stays nationwide.
According to MedPAC, the nonpartisan legislative branch agency that provides Congress with analysis and policy advice on the Medicare programs, nearly 3 in 5 IRF discharges involve stays covered by the Medicare Fee-for-Service (FFS) program.
This past week, the Centers for Medicare & Medicaid Services (CMS) announced the suspension of eight improvement activities under the Merit-Based Incentive Payment System (MIPS)
Clinical documentation integrity (CDI) has matured beyond its initial focus on coding accuracy and Diagnosis-Related Group (DRG) optimization. In 2025, it is central to payer
Please log in to your account to comment on this article.
Stop revenue leakage and boost hospital performance by mastering risk adjustment and HCCs. This essential webcast with expert Cheryl Ericson, RN, MS, CCDS, CDIP, will reveal how inaccurate patient acuity documentation leads to lost reimbursements through penalties from poor quality scores. Learn the critical differences between HCCs and traditional CCs/MCCs, adapt your CDI workflows, and ensure accurate payments in Medicare Advantage and value-based care models. Perfect for HIM leaders, coders, and CDI professionals. Don’t miss this chance to protect your hospital’s revenue and reputation!
Struggling with ICD-10-CM coding for diabetes and complications? This expert-led webcast clarifies complex combination codes, documentation gaps, and sequencing rules to reduce denials and ensure compliance. Dr. Angela Comfort will provide actionable strategies to accurately link diabetes to complications, improve provider documentation, and optimize reimbursement—helping coders, CDI specialists, and HIM leaders minimize audit risks and strengthen revenue integrity. Don’t miss this chance to master diabetes coding with real-world case studies, key takeaways, and live Q&A!
Uncover critical guidance. HIM coding expert, Kay Piper, RHIA, CDIP, CCS, provides an interactive review on important information in each of the AHA’s 2025 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s fourth quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Stay ahead of Medicare Advantage’s 2025-2026 regulatory changes in this critical webcast featuring expert Tiffany Ferguson, LMSW, CMAC, ACM. Learn how new CMS rules limit MA plan denials, protect hospitals from retroactive claim reopenings, and modify Two-Midnight Rule enforcement—plus key insights on omitted SDoH mandates and heightened readmission scrutiny. Discover actionable strategies to safeguard revenue, ensure compliance, and adapt to evolving health equity priorities before the June 2025 deadline. Essential for hospitals, revenue cycle teams, and compliance professionals navigating MA’s shifting landscape.
Struggling with CMS’s 3-Day Payment Window? Join compliance expert Michael G. Calahan, PA, MBA, CCO, to master billing restrictions for pre-admission and inter-facility services. Learn how to avoid audit risks, optimize revenue cycle workflows, and ensure compliance across departments. Critical for C-suite leaders, providers, coders, revenue cycle teams, and compliance teams—this webcast delivers actionable strategies to protect reimbursements and meet federal regulations.
Providers face increasing Medicare audits when using skin substitute grafts, leaving many unprepared for claim denials and financial liabilities. Join veteran healthcare attorney Andrew B. Wachler, Esq., in this essential webcast and master the Medicare audit process, learn best practices for compliant billing and documentation, and mitigate fraud and abuse risks. With actionable insights and a live Q&A session, you’ll gain the tools to defend your practice and ensure compliance in this rapidly evolving landscape.
Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.
Copyright © 2025 ICD10monitor. Powered by MedLearn Media.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
