Medical Billing Services

Updates to the IRF Quality Reporting Program

CMS recently announced the proposed rules for the ‘Inpatient Psychiatric Facility Prospective Payment System and Inpatient Rehabilitation Facility Prospective Payment System’ for FY 2022. This proposed rule would update the prospective payment rates for IRFs for Federal FY 2022. The proposed FY 2022 IRF Prospective Payment System rule would boost Medicare payments by 1.8%, or $160 M, compared to the previous fiscal year.

The payment rise includes a proposed ‘2.2%’ bang in IRF Prospective Payment System rates based on the proposed ‘2.4%’ market basket update, less a 0.2 percentage point multi-factor productivity adjustment.

Summary of Provisions of the Proposed Rule

  • In this proposed rule, CMS is recommended updating the IRF PPS for FYs 2022 and 2023. The proposed policy modifications and revises to the IRF prospective payment rates for FY 2022 are as follows:
  • Update the CMG relative weights and the average length of stay values for FY 2022, in a budget unbiased manner
  • Update the IRF PPS payment rates for FY 2022 by the market basket rise factor, based upon the most recent data available, with a productivity adjustment required by section 1886(j)(3)(C)(ii)(I) of the Act
  • Update the FY 2022 IRF PPS payment rates by the FY 2022 wage index and the labor-related share in a budget-unbiased manner
  • Describe the computation of the IRF standard payment conversion factor for FY 2022
  • Update the outlier threshold amount for FY 2022
  • Update the CCR (cost-to-charge ratio) ceiling and rural average CCRs for FY 2022

The proposed policy modifications and revises to the IRF QRP for FYs 2022 and 2023 are as follows:

  • Propose revisions and updates to quality measures and reporting requirements under the IRF QRP, as well as make requests for information as discussed in section VII. of this proposed rule.

The proposed rule contains a change to the outlier threshold to keep outlier payments at ‘3%’ in FY 2022. The adjustment would result in a ‘0.3%’ point decrease to overall outlier payments. The CMS has presented a plan to implement a COVID Vaccination Coverage among Healthcare Personnel (HCP) Measure to track vaccinations at ‘IRFs’. Rule.

The measure will also monitor whether IRFs are taking action to prevent the spread of coronavirus among their staff, help to sustain IRF ability to serve patients, and reduce transmission during this difficult time.

CMS is looking to tackle the health equity gap made poorer by the ongoing pandemic by gathering feedback on potential policy solutions and whether expanding measure development in the IRF Quality Reporting Program could support health impartial efforts.

Changes to the IPF Quality Reporting Program can reduce Medicare payments to facilities by ‘2%’ points based on quality measure performance.

The proposed rule also incorporated the exclusion of three chart-abstracted measures:

  • Alcohol Use Brief Intervention Provided or Offered and Alcohol Use Brief Intervention
  • Tobacco Use Treatment Provided or Offered and Tobacco Use Treatment
  • Timely Transmission of Transition Record by FY 2024

Medicare’s Fiscal Year (FY) launches each year on October 1. CMS is accepting comments on the proposed rules until June 7, 2021.

Reference: Proposed FY 2022 IRF Prospective Payment System rule


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