Regulatory Issues for Rehabilitation Facilities

Rehabilitation is a process to restore patients to useful life after an illness or surgery. Regulatory issues for rehabilitation facilities impact the resources available for a patient when the need arises.

Regulatory Issues

• Issues include the type and length of care a patient receives after an illness or surgery; convenience of the location of care received; increase in insurance premiums based on unnecessary hospital stays, income loss and lower workforce productivity. The 60 percent rule requires patients at inpatient rehabilitation facilities (IRF) to have one or more specific conditions for the facility to be paid by Medicare. If the patient does not meet criteria, then they may be moved to a facility less qualified to provide care or not receive care at all.

Who Determines the Issues

• Claims-processing contractors, also called intermediaries or carriers, apply Medicare coverage rules to determine the appropriateness of claims. These processors are non-government organizations that contract to serve as fiscal agents between providers and the federal government. An example of an intermediary is a commercial insurance company.

Solutions

• By providing workplace rehab facilities, patients could return to work sooner and receive employer support during the healing process. This would decrease income loss for patients, which would then increase workplace productivity.