CMS Clarifies Medical Review Policy for Intensive Rehabilitation Therapy
The Centers for Medicare & Medicaid Services has clarified its inpatient rehabilitation facility medical review guidelines to confirm that auditors should not deny claims solely because a therapy time threshold, commonly referred to as the “3-hour rule,” was not met. Effective March 23, when this standard is not met the auditor “shall use clinical review judgment to determine medical necessity…based on the individual facts and circumstances of the case, and not on the basis of any threshold of therapy time,” the guidance states. Contractors also should not deny claims “solely because the situation/rationale that justifies group therapy is not specified in the patient’s medical records at the IRF,” the guidance states.
Related News Articles
Headline
AHA May 23 submitted recommendations to the Department of Justice and Federal Trade Commission in response to the agencies’ requests for information on…
Headline
The Department of Health and Human Services May 13 announced a 60-day public comment period opened for stakeholders regarding its request for information to…
Headline
The Centers for Medicare & Medicaid Services today released a notice seeking public comment on the collection of information request regarding the State…
Headline
The Centers for Medicare & Medicaid Services April 11 released the fiscal year 2026 proposed rule for inpatient rehabilitation facilities. The rule would…
Headline
The Trump administration yesterday released executive orders on reducing anti-competitive regulatory barriers and repealing certain regulations deemed unlawful…
Headline
The Office of Management and Budget April 9 released a notice seeking public input on rules to potentially be rescinded, requesting detailed reasons…