The world of healthcare is becoming increasingly complex. Consequently, providers running inpatient rehabilitation programs are confronted with growing challenges – including the issue of reimbursement.

The primary reason is the strict patient qualification standards for acute rehab programs. Medicare and private payers have stringent criteria in place and will deny claims for rehab patients who don’t meet their requirements.

These rejections can result in significant costs for healthcare providers. Many are reporting denial rates as high as 80%-100%, resulting in losses of hundreds of thousands of dollars. With every rejection, they must redirect staff hours and other resources toward managing the extensive appeal process. This takes much-needed resources from patient care, making it difficult for rehab programs to achieve the highest levels of performance.

5 Strategies for Reducing Reimbursement Disputes

5 Top Strategies

For rehab programs to succeed, providers must minimize rejection-related losses. The five following strategies are some of the industry’s best practices for claim rejection management and prevention.

  1. Training for ADRs
    Staff must be trained on how to properly and promptly respond to Additional Document Requests (ADRs) from Medicare reviewers. Higher staff literacy in ADR procedure lowers reimbursement denial rates.
  2. Outsource Management of Appeal and Denial Process
    Allowing an outside partner to manage the Medicare and Medicare Advantage appeals and denials process relieves the burden on hospital staff and increases chances of success.
  3. Third-Party Audit Support
    A partnering agency can assess program practices, identify any clinical or administrative issues and give guidance on compliance with documentation requirements and clinical standards.
  4. Assistance with Regulatory Compliance and Guidelines
    Regulatory guidelines are constantly changing. Having resources dedicated to rehab, or receiving outside help with monitoring regulatory changes and ensuring compliance, relieves the burden on hospital administration.
  5. Regular Compliance Education
    Staff should attend regularly-scheduled conferences and webinars that cover new regulations and compliance strategies.

Implementing these strategies will strengthen your rehab program’s reimbursement practices and reduce rejections. If you would like to learn more about maximizing reimbursements, please read our white paper

Contact KHRS to learn how we can help your rehab program overcome reimbursement and regulatory challenges.  

By Kindred Hospital Rehabilitation Services