General

100.1 - General (Rev. 3220, Issued: 03-16-15, Effective: ICD-10: Upon Implementation of ICD-10, ASC-X12: 01-01-12, Implementation: 10-01-14, ICD-10: Upon Implementation of ICD-10 ASC X12: 09-16-14) The Omnibus Reconciliation Act of 1980 (Public Law 96-499, Section 933) defines CORFs (Comprehensive Outpatient Rehabilitation Facilities) as a distinct type of Medicare provider and adds CORF services as a benefit under Medicare Part B. The Balance Budget Act (P.L.105-33) requires payment under a prospective system for all CORF services. See Chapter 1, for the policy on A/B MAC (A) designations governing CORFs. See the Medicare Benefit Policy Manual, Chapter 12, for a description of covered CORF services. Physicians’ diagnostic and therapeutic services furnished to a CORF patient are not considered CORF physician’s services. The physician must bill the area A/B MAC (B) for these services. If they are covered, the A/B MAC (B) reimburses them via the MPFS. However, other services are considered CORF services to be billed by the CORF to the A/B MAC (A), and are also considered included in the fee amount under the MPFS. These services include such services as administrative services provided by the physician associated with the CORF, examinations for the purpose of establishing and reviewing the plan of care, consultation with and medical supervision of nonphysician staff, team conferences, case reviews, and other facility staff medical and facility administration activities relating to the services described in Medicare Benefit Policy Manual, chapter 12. Related supplies are also included in the MPFS fee amount. The CORFs bill Medicare with the ASC X12 837 institutional claim or Form CMS-1450 using HCPCS codes and Revenue Codes. Usually the zero level revenue code is used. Payment is based on the HCPCS code and related MPFS amount. Requirements in §§10 - 50 apply to CORF billing. In addition the following requirements apply.