On June 27, 2023, CMS hosted a Special Open Door Forum regarding its Review Choice Demonstration program for Inpatient Rehabilitation Facility Services (IRFs). CMS has stated that the Medicare IRF benefit continues to experience high levels of improper payments. The purpose of the Review Choice Demonstration is to establish a review choice process for IRFs to test for potential Medicare fraud and improve compliance with Medicare program requirements. IRF claim reviews are scheduled to begin in August in Alabama, and the program will then expand to Pennsylvania, Texas, and California. CMS also has future plans to expand to Medicare Administrative Contractor (MAC) jurisdictions JJ, JL, JH and JE (regardless of the physical IRF location).

Initially, IRFs will select between two review choices: (1) pre-claim review of all claims; or (2) post-payment review of all claims after final claim submission (this is the default selection if no choice is made). Every six months, a claim approval (or “affirmation”) rate will be calculated. If the IRF meets the target threshold, then the provider may select a subsequent review choice to: (1) continue with pre-claim review; (2) initiate selective post-payment review involving a statistically valid random sample of claims; or (3) spot check pre-payment review involving a random sample of 5% of claims.

For Alabama providers, the selection period for the first review cycle starts on July 7, 2023, and closes on August 6, 2023. The review dates will span August 21, 2023, through February 29, 2024.

A CMS webpage with additional information regarding the program is available here, and the June 27, 2023 Open Door Forum presentation is available here.