Inpatient Rehabilitation Medical Necessity Appeals

Critical Elements

  • Chapter One, Section 110 of the Medicare Benefit Policy Manual
  • Title 42 CFR, Part 412 –The 75% Rule
  • LCD, if applicable (Example: BCBS of Georgia L18887)

Best Practices

  • Include specific, detailed information from the patients chart referencing specific pages of the medical record.
  • Show that patient met criteria found in the Medicare Benefit Policy Manual 100-2, Chapter 1, Section 110.1 and any applicable Local Coverage Determination
  • Contain all supporting evidence & documentation.
  • Include table of contents and a paginated chart.

 

 

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