Notice to Alabama Providers of Upcoming Widespread Review of IRFs and IRUs Case Mix Group A2004
As a result of data analysis, Cahaba will soon be conducting a widespread review of Inpatient Rehabilitation Facilities (IRFs) and Inpatient Rehabilitation Units (IRUs) case mix group (CMG) A2004 (Miscellaneous with Motor Score from 12-32 and patient is 82 years old or older). No comorbidities. The topic code for this review will be 5146V. 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 the Centers for Medicare & Medicaid Services (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’s educational needs. Once completed, the results of this probe will be posted on our Web site.
Page last updated: Jan. 28, 2008
