Notice to Alabama Providers of Upcoming Widespread Review of IRFs and IRUs CMGs

As a result of data analysis, Cahaba will soon be conducting a widespread review of Inpatient Rehabilitaiton Facilities (IRFs) and Inpatient Rehabilitation Units (IRUs) Case Mix Groups (CMGs) A0704 & A0703 (Fracture of lower extremity), no comorbidities.

The topic code for this review will be 5145V.  Claims meeting the parameters of this edit will be selected across the provider community.  Once selected, the claims will be reviewed for medical necessity (e.g., compliance with CMS guidelines, contractor local coverage determinations (LCDs), correct billing and coding.  This will be a full claim review.  The data from this review will assist us in determining provider education needs.  Once completed, the results of this probe will be posted on our Web site. 

Page last updated: Jan. 8, 2008 Curved image to open content area.