60-day Comments

PUBLIC SUBMISSION

As of: 1/21/21 3:55 PM
Received: December 28, 2020
Status: Draft
Tracking No. 1k4-9kwm-4opo
Comments Due: February 16, 2021
Submission Type: Web

Docket: CMS-2020-0159
(CMS-10765) - Review Choice Demonstration for Inpatient Rehabilitation Facility
(IRF) Services
Comment On: CMS-2020-0159-0001
Agency Information Collection Activities; Proposals, Submissions, and Approvals
Document: CMS-2020-0159-DRAFT-0002
Comment on CMS-2020-0159-0001

Submitter Information
Name: Ronald Hirsch, MD
Address:
Elgin, IL, 60124
Email: [email protected]

General Comment
Re- CMS-10765/OMB control number: 0938-New
In the CMS document entitled- Review Choice Demonstration for Inpatient
Rehabilitation Facility Services- that was posted on the PRA listing at
https://www.cms.gov/regulations-andguidancelegislationpaperworkreductionactof1995pra-listing/cms-10765
It states:
Resubmissions will require additional documentation, when available
o Post-admission physician evaluation:
The purpose of the post-admission physician evaluation is to document the patient's
status on admission to the IRF (within 24 hours), compare it to that which is noted in

the preadmission screening documentation, and begin development of the patient's
expected course of treatment.
In CMS-1729-F, the requirement for a post-admission physician evaluation has been
eliminated. While it still may be performed, it is not required. While I understand that
"when available" indicates that it may not always be available, the inclusion of
"within 24 hours" sets a standard that is no longer required. I can envision a denial by
a MAC stating "the post-admission assessment was performed 32 hours after
admission and therefore the claim is denied."
This document should be changed and clarification added that a post-admission
evaluation, no matter what time is was performed, may be used to support the claim.

PUBLIC SUBMISSION

As of: 1/21/21 3:56 PM
Received: January 08, 2021
Status: Draft
Tracking No. 1k5-9l3t-hfto
Comments Due: February 16, 2021
Submission Type: Web

Docket: CMS-2020-0159
(CMS-10765) - Review Choice Demonstration for Inpatient Rehabilitation Facility
(IRF) Services
Comment On: CMS-2020-0159-0001
Agency Information Collection Activities; Proposals, Submissions, and Approvals
Document: CMS-2020-0159-DRAFT-0003
Comment on CMS-2020-0159-0001

Submitter Information
Name: Ronald Hirsch

General Comment
If records are reviewed as part of this program, either pre- or post-payment, the
admission should then be exempt from audit by any audit agency at any time unless
there is a credible fraud investigation. The past reviews by Maximus have clearly
demonstrated that the contracted audit agencies are ill equipped to properly interpret
the regulations regarding IRF admissions and qualifications.

PUBLIC SUBMISSION

As of: 1/21/21 3:55 PM
Received: December 28, 2020
Status: Pending_Post
Tracking No. 1k4-9kwk-cqte
Comments Due: February 16, 2021
Submission Type: Web

Docket: CMS-2020-0159
(CMS-10765) - Review Choice Demonstration for Inpatient Rehabilitation Facility
(IRF) Services
Comment On: CMS-2020-0159-0001
Agency Information Collection Activities; Proposals, Submissions, and Approvals
Document: CMS-2020-0159-DRAFT-0001
Comment on CMS-2020-0159-0001

Submitter Information
Name: Juli Martin
Address:
Saginaw, MI, 48602
Email: [email protected]

General Comment
I have been a Director for Inpatient Rehabilitation in Michigan for over 20 years.
During this time, the amount of charts audits and chart review have become an
overwhelming burden. My inpatient unit is very strict with admission and continued
stay criteria in an effort to prevent denials post discharge. We accept less than 30% of
the patients we screen. At this time, there is a significant disparity between the ability
to admit patients with Medicare and the patients with Medicare Advantage due to over
zealous denials and preferential discharge dispositions to skilled nursing facilities.
Patients are being denied care they desperately need and deserve, because insurance
companies are enacting rules that are not in accordance with CMS regulations. This
new audit proposal once again perpetuates the myth that inpatient rehabilitation units
are committing Medicare fraud. The burden to answer and appeal these audits is
overwhelming to the staff that would rather focus on quality measures and enhancing

outcomes. With the RAC audits, CMS has incentivized their contractors to deny
claims, without just cause.