Inpatient & Outpatient Rehabilitation

---

We have decades of experience working with inpatient rehabilitation hospitals and hospital units, their outpatient departments, and outpatient rehabilitation agencies and clinics. 

We counsel individual and chain inpatient rehabilitation facilities and outpatient rehabilitation providers on virtually every type of legal matter impacting their business, including: legislation, regulation, compliance, reimbursement, litigation, development, transactions and other issues.

•   Regularly counsel IRFs on the impact of federal legislation on their business

• Prepare written comments to IRF Medicare payment updates and other rulemakings on behalf of rehabilitation companies, including the IRF PPS and Physician Fee Schedule proposed rules
• Advise IRFs and other rehabilitation providers on Medicare regulations and policies that impact inpatient and outpatient rehabilitation, including rules concerning: conditions of participation, the 60% Rule, 15-hour rule for intensive rehabilitation, hospitals-within-hospitals, satellite facilities, IRF units, provider based entities, quality reporting, supervision of therapy assistants, telehealth, and remote therapeutic monitoring

• Regularly advise IRFs on 60% Rule calculation and compliance matters, coordination with Medicare MACs on 60% Rule testing
• Assist IRFs and outpatient rehabilitation providers with compliance programs, legal reviews of compliance issues, internal audits, and legally privileged independent audits
• Advise and assist with overpayment and other compliance disclosures to government agencies
• Advise IRFs and outpatient rehabilitation providers on corporate integrity agreement compliance and disclosures 
• Assist IRFs with Medicare claim review programs, including: Review Choice Demonstration for Inpatient Rehabilitation Facility Services, Targeted Probe and Educate (TPE) reviews, and other reviews by CMS contractors
• Counsel IRFs on compliance with the submission requirements for the IRF Patient Assessment Instrument (IRF-PAI) 

• Regularly counsel IRFs on the IRF prospective payment system (IRF PPS) and its payment adjustments, including high cost outliers, short stays, transfer cases, interrupted stays, rural adjustment, teaching adjustment, and low-income patient adjustment
• Advise IRFs on outlier reconciliation
• Assist IRFs and outpatient rehabilitation providers in obtaining written guidance from CMS and its components on regulatory issues
• Work with IRFs on proposed cost report adjustments and other reimbursement disputes to avoid the need for appeal 

• Federal and state court challenges to IRF regulations and reimbursement determinations
• Represent IRFs in administrative appeals of Medicare reimbursement disputes on cost report determinations before the Provider Reimbursement Appeals Board and CMS Administrator, and on claims determinations before Administrative Law Judges and the Departmental Appeals Board
• Represent IRFs and other rehabilitation providers in appeals challenging Medicare contractor claim reviews and audits
• Represent hospitals and other providers in Medicare decertification appeals to the Departmental Appeals Board 

• Negotiate lease agreements and ancillary services agreements for new hospitals-within-hospitals
• Assist hospitals in complying with the federal regulatory requirements and process for opening new IRFs and IRF units

• Perform regulatory due diligence for buyers and sellers in IRF transactions with an emphasis on IRF-specific regulatory and compliance issues
• Provide written opinions of relative risk associated with regulatory issues identified for target companies
• Advise and assist IRFs with government approvals and notifications in connection with licensure, certification, and accreditation requirements