CMS finalizes the 75% rule, eliminating polyarthritis as a qualifier

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The final verdict on the long anticipated 75% rule was released Friday by the Centers for Medicare & Medicaid Services with few changes from the proposed September ruling that had providers up in arms. The 75% rule defines key conditions an inpatient rehabilitation facility must meet in order to qualify for Medicare reimbursement.

In the final rule, CMS eliminated polyarthritis from a list of 10 qualifying patient conditions and added four other arthritis-related conditions and post-surgical care for certain joint replacements.

Changes also include a temporary three-year transition period, which lowers the 75% threshold – the percentage of patients who must be treated for one of the rule's qualifying conditions – to 50% the first year, 60% the following year and 65% the third year.

The regulation takes effect July 1. It will be published in the May 7 Federal Register.