In order for an IRF to be paid under the IRF PPS instead of the acute care hospital inpatient PPS, the 75 percent rule previously required that a certain percentage of the facility’s patients require intensive multidisciplinary inpatient rehabilitation and have one or more of 10 medical conditions. In 2004, CMS updated the 75 percent rule by further defining one of the qualifying conditions, “polyarthritis,” which resulted in a final list of 13 qualifying medical conditions.
Full Answer
Will the 75% rule be the most costly decision in healthcare?
In the end, it is possible that the 75% rule will prove to be one of the most financially expensive, patient-discriminatory decisions made by a healthcare agency in the past decade. Admission to an IRF should be based on individual patient functional status and his or her predicted benefit from an acute inpatient stay, rather than diagnosis alone.
When did Medicare take effect?
In 1966, Medicare’s coverage took effect, as Americans age 65 and older were enrolled in Part A and millions of other seniors signed up for Part B. Nineteen million individuals signed up for Medicare during its first year. In 1972, President Richard M. Nixon signed into the law the first major change to Medicare.
What is the 75% rule in nursing?
The 75% rule is a very blunt instrument, and a poor attempt at reducing inpatient rehabilitation costs. It is likely to promote dishonest charting. (For example, a patient whose admission diagnosis is not one of the 13 listed in the 75% rule might have a secondary diagnosis that would qualify.
Will Medicare changes take longer in the Senate?
While the House passed the Medicare changes as standalone legislation, the journey the changes will take in the Senate is a little trickier— which could be a good thing. (This is where staying awake in civics class pays off.)
What is the 75% rule Medicare?
Commonly referred to as the "75% rule," IRFs must prove that 75% of their patients have 1 of only 13 diagnoses. Otherwise, the facility risks losing all reimbursement from Medicare, for all hospital admissions to the IRF in that fiscal year.
What is the IPPS rule?
The Centers for Medicare & Medicaid Services today issued a proposed rule that would increase Medicare inpatient prospective payment system rates by a net 3.2% in fiscal year 2023, compared with FY 2022, for hospitals that are meaningful users of electronic health records and submit quality measure data.
Does Medicare reimbursement adjusted for inflation?
A feature of each payment system is an annual adjustment reflecting rising input costs, as measured by “market baskets” created specifically for the various provider groupings. Thus, as inflation rises, so too do the base payments for a wide array of Medicare-covered services.
What is Medicare IPPS?
The system for payment, known as the Inpatient Prospective Payment System (IPPS), categorizes cases into diagnoses-related groups (DRGs) that are then weighted based on resources used to treat Medicare beneficiaries in those groups.