The Centers for Medicare & Medicaid Services (CMS) has issued the Final Rule for inpatient rehabilitation facilities (IRFs) that takes effect Oct. 1. The rule updates payment policies for the 2022 fiscal year (FY), updates IRF Quality Reporting Program (QRP) requirements for FY 2022, and addresses comments related to the requests for information associated with the proposed rule.
We have summarized the major components below:
Following standard methodology, CMS has finalized updates to the IRF payment rates, providing for a net increase in payments of 1.5 percent, or $130 million, as compared to FY 2021. This increase, which is somewhat lower than the increase in the proposed rule, is based on an update to the IRF PPS payment rates by 2 percent, based on the IRF market basket update of 2.6 percent, less a 0.7-percentage point multi-factor productivity (MFP) adjustment. This brings the final FY 2022 standard payment conversion factor to $17,240, as compared to $16,856 for FY 2021.
The final rule also adjusts the outlier threshold to maintain outlier payments at 3.0 percent in FY 2022. The adjustment will result in a 0.4-percentage point decrease to overall outlier payments.
There has been no change to the penalty for failure to meet the reporting requirements, and IRFs that do not meet reporting requirements will continue to be subject to a 2-percentage point reduction in their annual increase factor.
In efforts to address COVID-19 and assess whether organizations are taking steps to limit the spread of the virus among their healthcare personnel, CMS has finalized a measure to require IRFs to report COVID-19 HCP vaccinations.
The data will be reported through the National Healthcare Safety Network (NHSN) Healthcare Personnel Safety (HPS) component – not on the IRF-PAI. The submission requirements are as follows:
The final rule also updates the denominator for the transfer of health (TOH) information to the Patient-Post Acute Care (PAC) quality measure by excluding patients who are discharged home under the care of an organized home health service or hospice from the denominator.
Of note:
In response to the public health emergency (PHE) for COVID, CMS released an interim final rule (85 FR 27595 through 27596), which delayed the compliance date for the collection and reporting of the transfer of health information measures for at least one full fiscal year after the end of the PHE.
CMS acknowledged comments from the field in response to requests for information related to Fast Healthcare Interoperability Resources (FHIR)-based standards and the expansion of data collection for several standardized patient assessment data elements (SPADEs), which include several social determinants of health (SDoH). The agency noted that work will continue in the areas.
The Final Rule (CMS-1748-F) can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection/current
Review the associated CMS fact sheet here:
I am having a disagreement with the Centers for Medicare & Medicaid Services (CMS) that is worth discussing. As I have been teaching for the
That’s how Centers for Medicare & Medicaid Services (CMS) Administrator Mehmet Oz announced the publication of the CMS Final Rule on the Adoption of Standards
Please log in to your account to comment on this article.
Breast biopsy procedures may be clinically straightforward but accurately translating them into compliant billing can be anything but. In this focused webcast, Shawn Blackburn, CPC, CPMA, CIC, CRC, CCS-P breaks down how imaging guidance, lesion count, laterality, and payer expectations all impact how these procedures should be reported. Through clear explanations and real-world scenarios, you’ll gain practical insight into aligning clinical workflows with billing requirements, avoiding common pitfalls, and ensuring your documentation supports accurate reimbursement and compliance.
Gain clarity and confidence in OB‑GYN coding with this expert‑led webcast featuring Sherri L. Clayton, RHIT, CSS. You’ll learn how to apply global maternity package rules accurately, select the right CPT codes for procedures and visits, and identify documentation gaps that lead to denials. With practical guidance and real examples, this session helps you strengthen compliance, reduce audit risk, and ensure accurate reimbursement for women’s health services.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Traditional utilization management models can no longer keep pace with regulatory shifts, payer scrutiny, and operational pressures. In this webcast, Tiffany Ferguson, LMSW, CMAC, ACM, ACPA-C, introduces an Adaptive Model strategy that modernizes UM through role specialization, technology-driven workflows, and proactive, team-based processes. Attendees will learn how to restructure programs to improve efficiency, strengthen clinical collaboration, and enhance financial performance in a rapidly changing healthcare environment.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Happy HIP Week! Sign up to win free access to our 2026 Coding Clinic Update Webcast Series! Click here to learn more →
Celebrate Lab Week with MedLearn! Sign up to win one year of our Laboratory All Access Pass! Click here to learn more →
Have a Medicare regulation question you’d love Dr. Hirsch to answer? Now is your chance! CLICK HERE to learn more→
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
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. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
