IRF PA Review Choice Program

 It's a cliche' that generally, Parts A and B don't involve prior authorization.  CMS has recently instituted new guardrails around Medicare Advantage prior authorization (and coverage policies) and Congress has toyed with legislation on insurers and PA.  It's also a big topic for AMA.

There's a program for inpatient rehab hospitals (IRFs) to have EITHER prior auth or post pay review of all their claims, in a number of large MACs.  It's called "IRF Review Choice Demonstration" or IRF RCD.

https://www.cms.gov/files/document/r12080otn.pdf

https://www.cms.gov/research-statistics-data-systems/medicare-fee-service-compliance-programs/prior-authorization-and-pre-claim-review-initiatives/review-choice-demonstration-inpatient-rehabilitation-facility-services#:~:text=The%20Review%20Choice%20Demonstration%20(RCD,compliance%20with%20Medicare%20IRF%20rules.

https://www.aapmr.org/members-publications/member-news/member-news-details/2021/10/12/aapm-r-submits-comments-to-cms-opposing-review-choice-demonstration-for-irf-services#:~:text=The%20IRF%20review%20choice%20demonstration,several%20Medicare%20Administrative%20Contractor%20jurisdictions.

https://calhospital.org/cms-announces-start-of-irf-review-choice-demonstration/