Changes are effective Oct. 1, 2019
In this article, we aim to continue to remind Inpatient Rehabilitation Facilities (IRFs) of the looming transition from utilizing Functional Independence Measures (FIMtm) for the purposes of assigning patients to a case-mix group (CMG) to the use of key quality indictor data – specifically the GG Self-Care and Mobility codes – for CMG placement and Medicare fee-for-service payment for IRF admissions.
As Oct. 1, 2019, rapidly approaches, IRFs need to be in the final stages of training and preparation. Patients who are discharged on or after Oct. 1, 2019, will be paid based on the new formula.
Changes in the Final Rule
Related to this topic, the final rule for the 2020 fiscal year was published in the Federal Register on Aug. 8, 2019. The final rule closely matched the proposed rule, but it is noteworthy that several provisions were not finalized, including the weighting of the motor score for CMG placement and the requirement to submit quality indicator data for all patients regardless of the payor. CMS noted that delaying the weighting of the scores would provide IRFs with an easier transition under the revised formulas, but for IRFs that have calculated payment impact under the proposed formula, there is a need to take a second look.
Final Steps in Preparation
Because the changes impact patients discharged on or after Oct. 1, IRFs need to be ready by mid-September to ensure that data collected for patients with an average length of stay of approximately 13 days is accurate and complete.
Again, while we’ve been collecting the data for several years, IRFs have focused on the accuracy of other data elements, and we have found in working with clients that they are facing challenges with scoring these elements and providing detailed documentation – not just a number – to support the scores.
Determine the Updated Impact
Along with the final rule for 2020, CMS posted updated rate-setting files. IRFs can download the July 31, 2019, updated files at this link: Data Files. The rate-setting file will allow IRFs to calculate impact based on the updated formula, which does not weight the GG Functional Quality Indicators.
Finalize Documentation Changes
IRFs should be trialing any changes to their EMRs or paper templates now to ensure that workflow is efficient and that the correct scores and documentation to support them are present.
Train, Train, Train
For staff who have utilized FIMtm measures for many years, the switch in language and scoring may be difficult – old habits are hard to break, and this could significantly impact scoring accuracy and thus payment. Changing language to match the scoring definitions is essential in breaking the cycle.
Train, Audit, and Retrain
Review of scoring in “live” records will allow IRFs to identify and support training needs. This cycle should continue well past implementation.
What’s the Bottom Line?
The clock keeps ticking! We’re down to just six weeks before the transition, and should be finalizing training and form implementation now.
Like many of you, I am deathly allergic to clinical documentation integrity (CDI), but do not worry; I premedicated with prednisone and an antihistamine prior
Price transparency in healthcare has long been a stated priority for the Trump Administration, both the first and second, and several recent public moves have
Please log in to your account to comment on this article.
Stop revenue leakage and boost hospital performance by mastering risk adjustment and HCCs. This essential webcast with expert Cheryl Ericson, RN, MS, CCDS, CDIP, will reveal how inaccurate patient acuity documentation leads to lost reimbursements through penalties from poor quality scores. Learn the critical differences between HCCs and traditional CCs/MCCs, adapt your CDI workflows, and ensure accurate payments in Medicare Advantage and value-based care models. Perfect for HIM leaders, coders, and CDI professionals. Don’t miss this chance to protect your hospital’s revenue and reputation!
Struggling with ICD-10-CM coding for diabetes and complications? This expert-led webcast clarifies complex combination codes, documentation gaps, and sequencing rules to reduce denials and ensure compliance. Dr. Angela Comfort will provide actionable strategies to accurately link diabetes to complications, improve provider documentation, and optimize reimbursement—helping coders, CDI specialists, and HIM leaders minimize audit risks and strengthen revenue integrity. Don’t miss this chance to master diabetes coding with real-world case studies, key takeaways, and live Q&A!
Uncover critical guidance. HIM coding expert, Kay Piper, RHIA, CDIP, CCS, provides an interactive review on important information in each of the AHA’s 2025 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s fourth quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Stay ahead of Medicare Advantage’s 2025-2026 regulatory changes in this critical webcast featuring expert Tiffany Ferguson, LMSW, CMAC, ACM. Learn how new CMS rules limit MA plan denials, protect hospitals from retroactive claim reopenings, and modify Two-Midnight Rule enforcement—plus key insights on omitted SDoH mandates and heightened readmission scrutiny. Discover actionable strategies to safeguard revenue, ensure compliance, and adapt to evolving health equity priorities before the June 2025 deadline. Essential for hospitals, revenue cycle teams, and compliance professionals navigating MA’s shifting landscape.
Struggling with CMS’s 3-Day Payment Window? Join compliance expert Michael G. Calahan, PA, MBA, CCO, to master billing restrictions for pre-admission and inter-facility services. Learn how to avoid audit risks, optimize revenue cycle workflows, and ensure compliance across departments. Critical for C-suite leaders, providers, coders, revenue cycle teams, and compliance teams—this webcast delivers actionable strategies to protect reimbursements and meet federal regulations.
Providers face increasing Medicare audits when using skin substitute grafts, leaving many unprepared for claim denials and financial liabilities. Join veteran healthcare attorney Andrew B. Wachler, Esq., in this essential webcast and master the Medicare audit process, learn best practices for compliant billing and documentation, and mitigate fraud and abuse risks. With actionable insights and a live Q&A session, you’ll gain the tools to defend your practice and ensure compliance in this rapidly evolving landscape.
Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.
Copyright © 2025 RACmonitor. Powered by MedLearn Media.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
