Inpatient Rehab Facility

Inpatient Rehab Facility Payments from Medicare Go Up 2.4% for 2021         

In 2021, in a final rule updating the Inpatient Rehabilitation Facility Prospective Payment System, the Centers for Medicare and Medicaid Services has elevated payments by 2.4% for inpatient rehab facilities.

In addition to it, CMS has increased collective payments by 0.4% in order to maintain the outlier payments by 3% of the total payments. This will result in an overall update of $260 million for the fiscal year 2020.

The final rule also states a decrease of 5% cap on wage index from 2020-21, this line up with the recent office of Management and Budget statistical area allocations.

Additional Changes in the CMS Rule Apart from the Payments

Not only are the payments affected there are other rules deduced too which includes:

Post-admission evaluation

During the COVID-19 emergency, the rule where physicians were required to perform a post-admission evaluation on a new inpatient within 24 hours of admission was suspended. As per these new rules, CMS now eliminates the requirements for that evaluations permanently. This rule is instigated post-admission, so pre-admission evaluation is still required. This means that the second evaluation was found to yield minimal benefit.

Non-physician practitioner allowed for one required visit

When the patient arrives in an inpatient rehab facility, the assigned physician must visit the patient at least thrice a week to ensure that the care plan for the patient is working the way it was intended. The new rule states that there is an allowance for one of the three required weekly visits that need to be performed by a non-physician practitioner, starting in the second week of admission of the patient.

These practitioners are regularly part of the patient’s treatment team as long as the program term. They also have training and experience in providing care to this vulnerable population. Physicians still have the flexibility that they can see each patient three or more times each week.

What’s the Impact of these Rules?

The final provision of rules codifies and updates existing instructions and guidance related to Medicare IRF coverage necessities.

For a claim to be considered rational and necessary, a reasonable expectation is required that meets all the requirements of IRF at the time of the patient’s admission to the inpatient rehab facility. The new rule is known to have reduced the burden from the administration of both IRF and Medicare contractors in making a patient claim.

Moving further, the next rule eliminates the need for a post-admission physician evaluation permanently.

As mentioned above, due to the COVID-19 situation, IRFs were required to conduct a post-admission physician evaluation within 24 hours of admission of the patient. Due to this pandemic, an update in rules came up. Now physicians have the flexibility and don’t require post-admission evaluation.

CMS at the moment requires the physicians to keep a check on their patients three times a week to make sure the patient’s care plan is going as intended.

As compared to the rules proposed in April, the final rule is slightly different. Originally, CMS planned these rules to make an update of 2.9% or $270 million for the fiscal year 2021.

The rule that was proposed included the 5% cap on wage index decreases from 2020-21, the provisions allowed non-physicians Medicare provider to perform visit patients and eliminate post-admission physician evaluation.

The final rule additionally advances to lessen efforts of departments and this strengthens the Medicare program.


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