Medical necessity: Is current documentation practice and payment denial limiting access to inpatient rehabilitation?

American Journal of Physical Medicine and Rehabilitation

Volumn 88, Issue 9, 2016, Pages 755-765

  Granger, Carl V ^a,b   Carlin, Marsha ^a,b   Diaz, Pedro ^b   Dorval, Jane ^c   Forer, Steve ^d   Kessler, Corby ^e   Melvin, John L ^f   Miller, Lawrence S ^g,h   Riggs, Richard V ⁱ   Roberts, Pamela ⁱ  

^a UNIVERSITY AT BUFFALO   (United States)

^b Uniform Data System for Medical Rehabilitation   (United States)

^c Function Forever LLC   (United States)

^d Chevron Texaco   (United States)

^e Queen of the Valley Hospital   (United States)

^f THOMAS JEFFERSON UNIVERSITY   (United States)

^g UNIVERSITY OF CALIFORNIA   (United States)

^h Medical Consultant for Medicare   (United States)

ⁱ CEDARS SINAI MEDICAL CENTER   (United States)

Author keywords

CMS; Inpatient; IRF; Medical necessity; Medicare; Rehabilitation

Indexed keywords

ADMINISTRATIVE PERSONNEL; BARK; DOCUMENTATION; HOSPITAL PATIENT; HUMAN; MAJOR CLINICAL STUDY; MEDICAL CARE; MEDICARE; PRACTICE GUIDELINE; REHABILITATION; REHABILITATION CENTER;

EID: 84983801466     PISSN: 08949115     EISSN: 15377385     Source Type: Journal    
DOI: 10.1097/PHM.0b013e3181aa71a8     Document Type: Article

References (6)

1. Sage WM: Managed care's Crimea: Medical necessity, therapeutic benefit, and the goal of administrative process in health insurance. Online Duke Law J 2003;53:597. Available at: http://www.law.duke.edu/shell/cite.pl?53+Duke+L.+J.+597. Accessed July 21, 2008
2. Bakhtari E: CMS' move to relax medical necessity restrictions helps hospitals maintain financially viable rehab facilities both on- and off-campus. Available at: http://www.healthleadersmedia.com/content/207478/topic/WS-HLM2-FIN/Rehab-realignment.html. Accessed July 23, 2008
3. American Medical Rehabilitation Providers Association. PPS-excluded rehabilitation hospitals, units, and beds by state, 2002-2007, preliminary analysis. AMRPA Magazine 2007;10:46-9
4. Healthcare Financial Management Association, Connelly RS, Thomas PW: Solving the riddle of inpatient rehabilitation coverage. HFM Magazine, March 2007, pp 98-104
5. American Hospital Association. Limiting access to inpatient medical rehabilitation: A look at payment denials for Medicare patients treated in inpatient rehabilitation facilities. October 2007. Available at: http://www.aha.org/aha/content/2007/pdf/071003rehablcd.pdf. Accessed August 19, 2008
6. American Academy of Physical Medicine and Rehabilitation. Melvin JL, Gans B, Chan L, et al as the Medical Inpatient Rehabilitation Criteria Task Force. Standards for assessing medical appropriateness criteria for admitting patients to rehabilitation hospitals or units. 2006. Available at: http://www.aapmr.org/zdocs/hpl/MIRC0906.pdf. Accessed July 29, 2008