Mediware Rehabilitation Blog
Modifier alerts occur when CMS attempts to further differentiate the services provided and whether those services are payable as distinct and separately. Way back in 1996, NCCI edits began and have evolved to mutually exclusive and component codes that are generally considered non-payable on the same date of service. This is true unless you append that line on your bill with the 59 MODIFIER that specifically permits the 'unbundled' payment. How often have you used or needed to use the modifier in your practice? Some facilities, by the nature of what they do, will systematically trigger the need more often. Let's discuss because the new 'X' modifiers are causing some 'ruckus'. There is more than a month to plan and educate... now let's discuss if you are one of those practices!
It's Oct. 1, 2014, and that signals a fiscal year for Inpatient Rehabilitation Facilities. The 2015 Final Rule is now in place and the changes that come with this date begin with all discharges beginning today (10/1/14).
Let's revisit some helpful LINKS and information so that you can check off your list of things to do beginning now!
Inpatient Rehabilitation as a specialty is being challenged more each day for the care and skills uniquely provided in the IRF/U environment. Continuing to defend the highly individualized and specific skill sets of patients that enter IRF somehow are not apparent because 'Rehabilitation' as a word has been highly generic in terms of explaining recovery for just about any impairment. CARF certification standards certainly demonstrate that the basic expectations for a rehabilitation level of care are highly unique, individualized and specialized for the patient population treated; each year CARF provides opportunities for comment on new standards. An invitation just arrived. Please be a part of this review!
90 percent seems like a good number unless it's 90 percent incorrect. Recently, CMS hired Strategic Health Solutions as their Supplemental Medical Review Contractor (SMRC) to look at IRF/U documentation and see if it was meeting the required medical necessity documentation and regulatory requirements. Unfortunately, the findings were not in favor of payment. Let's look at what they discovered. If you haven't heard it loud and clear you MUST audit your own records for the appropriate elements of charting or you too could be in the risk pool for non-payment.
If you were a part of this initial review, AMRPA would like to speak to you!