CMS Responds to OIG Review of Rehab Facilities

James Carroll, for HealthLeaders Media , August 18, 2010

Of particular note to providers in this report is the CMS response. CMS administrator and Chief Executive Officer Marilyn Tavenner indicated that CMS will share the OIG audit information with the RACs and "encourage them to consider these findings as they decide what claims to review," according to Beckley.

Another item of which IRFs should take notice is the sampling period used by the OIG in the transfer regulation review from FY 2004---2007, according to Tanja Twist, MBA/HCM, director of patient financial services at Methodist Hospital of Southern CA in Arcadia. "In her May 13 response to the OIG's draft report, Tavenner specifically states that CMS concurs with the look back period identified by the OIG," she says. "Providers should take note that not only does CMS intend to recover the $1.2 million in overpayments, but they also plan to implement the OIG's recommendation to review and potentially recover the entire population of claims in the sample period."

CMS implemented an edit in the common working file to identify transfer cases for IRF in April 2007. Prior to that, the OIG estimates that based on their total sample size of 5,703 claims reviewed between 2004 and 2007, there were between $34 and $37 million in overpayments paid to providers, according to Twist.

CMS seems to clearly separate the sampling period as being outside the scope of the RACs, so providers may be asked to pull IRF records dating back to FY 2004 for review and potential recoupment by the FI and Medicare administrative contractors (MACs), according to Twist.

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