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Written by: Dennis Stevenson Jr., MBA on Friday, January 8, 2016 Posted in: Inpatient Rehab

Prepare for new requirements to avoid paying costly penalties

Happy New Year!

As we move into 2016, it’s not too soon to start thinking about October 1, 2016. This is the date that CMS expects all IRFs receiving payment under the IRFPPS to move to version 1.4. If you don’t know what that means, it’s a good idea to start looking.

In a nutshell, CMS is drastically expanding the data collection requirements of the IRF-PAI and the Quality Reporting program. The expansion is so dramatic that the final report (which must be completed for every Medicare patient) will grow from 8 pages to 18 pages. The majority of this expansion falls within the Quality Reporting program.

Managing this change is an important financial step for every IRF provider. According to Medicare estimates, FY 2016 payments to 869 hospital-based IRFs will exceed $4 billion and will reach nearly $3.7 billion in payments to 266 free-standing IRFs. Because CMS is attaching a 2% penalty to non-compliance with the Quality Reporting program, failure to respond appropriately to these changes places an estimated $155 million of IRF revenue at risk across the industry.

The amount of your revenue at risk depends on the size of your organization and your level of preparedness for the new requirements that will go into effect on October 1, 2016. What is certain, however, is that doing nothing will be a costly option.