Year: 2006
Type: article
Abstract: There is little doubt as to the pressure from Washington to control health care costs through the Centers for Medicare and Medicaid Services (CMS).Inpatient rehabilitation facilities (IRFs) have been targets of this mission through legislation known as the 75% Rule (the Rule).Published originally in 1983, its purpose was to define eligibility for IRF payment reimbursement by mandating that 75 percent of admissions have one of ten diagnoses.Upon revisiting the Rule in the late 90s, CMS concluded that it was applied inconsistently among IRFs, suggesting the need for clearer criteria to avoid what it deemed to be abuse of the guidelines.CMS expanded the list of diagnoses to thirteen and mandated strict adherence to avoid overpayment for unneeded services (see Figure 1).This article explores two recent briefs, from CMS and from the American Hospital Association (AHA), that demonstrate the perspectives of stakeholders regarding the Rule and its effects on the field of rehabilitation.
Source: The Medicine Forum
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W178605507