April 22, 2009

Review of Interrupted Stays at Inpatient Rehabilitation Facilities for Calendar Years 2004 and 2005

The federal Department of Health and Human Services Office of the Inspector General (OIG) reviewed claims for inpatient rehabilitation facilities (IRFs) to determine if the facilities billed correctly for interrupted Medicare stays during 2004 and 2005. The Centers for Medicare and Medicaid Services requires that if a patient returns within three days after discharge, the return stay must be billed as part of the initial stay, not a new stay. The auditors found that in 2004 and 2005, 448 IRFs incorrectly billed Medicare for 986 interrupted stays out of a total of 500,264 claims involving 1,233 IRFs in calendar year 2004 and $6.3 billion for 442,461 claims involving 1,243 IRFs in 2005.