Prior Authorization and Pre-Claim Review Initiatives
Review Choice Demonstration for Inpatient Rehabilitation Facility Services
The Review Choice Demonstration (RCD) for Inpatient Rehabilitation Facility (IRF) Services provides flexibility and choice for IRFs, as well as a risk-based approach to reduce burden on providers demonstrating compliance with Medicare IRF rules. IRFs will initially select between two review choices:
- Choice 1: Pre-claim review
- Choice 2: Postpayment review
After a 6-month period, IRFs demonstrating compliance with Medicare rules through their pre-claim review affirmation rate or postpayment review approval rate will have additional review choices to select from. IRFs may select from one of the three subsequent review choices:
- Choice 1: Continue with Pre-Claim Review
- Choice 3: Selective Postpayment Review
- Choice 4: Spot Check Prepayment Review
This program reduces the number of Medicare appeals, improves provider compliance with Medicare program rules, does not alter the Medicare IRF benefit, and should not delay care to Medicare beneficiaries. This RCD protects our programs' sustainability for future generations by serving as a responsible steward of public funds.
Please send questions to IRF_RCD@cms.hhs.gov.
Timeline & Updates
Updates are provided in reverse chronological order; scroll down for earlier updates.
Beginning August 21, 2023, CMS will implement the Review Choice Demonstration (RCD) for IRF services in Alabama. IRF providers can make their review choice selection of either 100% pre-claim review or 100% postpayment review at the Palmetto GBA Provider Portal on the following dates:
Selection Period Start Date: July 7, 2023
Selection Period End Date: August 6, 2023
CMS will update this website with additional resources in the coming weeks.