Pre-Claim Review Demonstration for Inpatient Rehabilitation Facility Services (CMS-10765)

The Centers for Medicare & Medicaid Services (CMS) is requesting the Office of Management and Budget (OMB) approval for the Review Choice Demonstration for Inpatient Rehabilitation Facility (IRF) Services. This demonstration will assist in developing improved procedures for the identification, investigation, and prosecution of potential Medicare fraud. By ensuring that payments for IRF services are appropriate through either pre-claim or postpayment review, this demonstration also works toward the prevention and identification of potential fraud, waste, and abuse, as well as protecting the Medicare Trust Funds from improper payments while reducing Medicare appeals. CMS proposes performing the demonstration in Alabama, Pennsylvania, Texas, and California, as well as IRFs in any state that bill to the Medicare Administrative Contractor (MAC) jurisdictions JJ, JL, JH, and JE.

The latest form for Pre-Claim Review Demonstration for Inpatient Rehabilitation Facility Services (CMS-10765) expires 2027-10-31 and can be found here.