Inpatient rehabilitation facility reviews resume for Medicare Plus Blue claims, starting Oct. 1

Cotiviti, an independent company that provides claim reviews for Blue Cross Blue Shield of Michigan, will resume auditing Medicare Plus Blue℠ PPO inpatient rehabilitation facility claims Oct. 1, 2024.

Audits will:

• Include a one-year look-back at claims.
• Check patient-met criteria for admission to inpatient rehabilitation facilities.
• Confirm billed case mix group codes.
• Detect, prevent and correct waste and abuse.
• Facilitate correct claim payment.

Be ready to share medical charts. After an audit, Cotiviti will send you a letter with the findings and information on how you can ask for an appeal, if necessary.

Medical criteria information

Inpatient rehabilitation facility level of care is reasonable and necessary if the patient meets all requirements. Cotiviti will confirm that you’ve properly documented the requirements for inpatient rehabilitation facility level of care, including the following:

• Physician order
• Patient supervision by a rehabilitation physician
• Physician visits
• Patient’s need for active and ongoing therapeutic intervention of multiple therapy disciplines

Questions?

Contact Cotiviti Provider Relations at 770-379-2009 from 8 a.m. to 5 p.m. Eastern time Monday through Friday.