The FAIR Fund, or the Fund for Access to Inpatient Rehabilitation, is a common legal defense fund comprised primarily of leaders of inpatient rehabilitation hospitals and units who have organized to bring legal challenges to overly restrictive interpretations of medical necessity, burdensome documentation, and violations of procedural requirements by Medicare contractors.
The FAIR Fund’s mission is to raise awareness of, and build support for, policies that will preserve and increase access to inpatient hospital rehabilitation. Members and supporters of the FAIR Fund believe that exercising the legal rights of providers is vital, and providers must challenge the restrictions in access to inpatient hospital rehabilitation that the Centers for Medicare and Medicaid Services (CMS) and its contractors have systematically pursued in the recent past.
The FAIR Fund seeks to establish precedent-setting decisions with widespread application at the federal court level that will clarify medical necessity and documentation requirements for inpatient hospital rehabilitation and ensure that Medicare contractors use proper procedures when auditing claims. The FAIR Fund will also challenge extensive delays in Medicare appeals and seek a global resolution of pending and future overpayment determinations, for the benefit of the entire IRF field.
CURRENT FAIR FUND PRIORITIES
The FAIR Fund has three immediate areas of focus in the coming months and years:
- Preserving Access to Patient Care:
- Challenging the Centers for Medicare & Medicaid Services (CMS) to ensure access to inpatient rehabilitation facility (IRF) care
- Eliminating overly restrictive interpretations of medical necessity
- Opposing overly aggressive actions by Medicare contractors
- Reducing Denials; Lessening Provider Burden:
- Seeking more accurate reviews of IRF claims by better defining medical necessity of IRF admissions
- Ensuring government contractors have sufficient training and expertise in medical rehabilitation
- Eliminating denials based on guidance documents rather than regulatory requirements
- Reducing the sheer number of audits from multiple Medicare contractors
- Opposing the IRF Review Choice Demonstration as a dramatic overreach by the federal government
- Limiting prior authorization and the use of proprietary coverage guidelines under Medicare Advantage
- Increasing the weight given to rehabilitation physician judgment in IRF treatment decisions
- Challenging IRF denials based on hyper-technical interpretations of Medicare standards
- Allowing IRFs to Focus on their Mission:
- Providing FAIR Fund members with resources to submit strong, compelling appeals when denials occur
- Facilitating communication among IRF providers on best practices in demonstrating medical necessity
- Empowering IRFs to spend their time treating patients and improving health and functional outcomes
Negotiated a global settlement with CMS to settle IRF appeals which contains the most generous settlement terms of any global settlement in recent Medicare history.
Engaged federal agencies and Congress to improve access to IRF care, including promoting improvements in regulations, proposing regulatory relief, opposing the use of non-Medicare coverage guidelines by Medicare Advantage plans, and encouraging reforms to the Medicare audit and appeals process.
Participated in litigation to force the Department of Health and Human Services (HHS) to decide ALJ appeals within the 90-day deadline required by the Medicare statute, which dramatically reduced the massive ALJ backlog. The FAIR Fund convinced the Court of Appeals that the backlog harms patient health and welfare.
Opposed Recovery Audit Contractors (RACs) in litigation in the Ninth Circuit Court of Appeals.
FAIR Fund Membership
Burke Rehabilitation Hospital
Casa Colina Hospital and Centers for Healthcare
HMH JFK Johnson Rehabilitation Institute
Madonna Rehabilitation Hospital
Magee Rehabilitation Hospital
Mary Free Bed Rehabilitation Hospital
Methodist Rehabilitation Center
Reading Hospital Rehabilitation at Wyomissing
Rehabilitation Institute of Michigan
Sheltering Arms Institute
Spaulding Rehabilitation Network
OFFICERS AND EXECUTIVE COMMITTEE MEMBERS
President – Gary Armstrong, Methodist Rehabiliation Center
Vice President – Debra Schultz, Casa Colina Hospital and Centers for Healthcare
Treasurer/Secretary – Tom Smith, MossRehab
Immediate Past President – Mary Beth Walsh, Burke Rehabilitation Center
Member At Large – Phil Loverso, Casa Colina Hospital and Centers for Healthcare
Member At Large – Justin Hunter, Encompass Health
Member At Large – Chris Carey, Select Medical
FAIR FUND MEMBERSHIP BENEFITS
FAIR Fund Compendium – A compendium of Medicare audit and appeal materials, including key guidance and user-friendly template appeals so that members can present compelling cases to win payment for IRF services.
Annual Consultation – An annual consultation with FAIR Fund counsel to discuss Medicare audits and appeals.
Regular Updates – Regularly updates on CMS policies, litigation, and congressional actions that impact IRFs.
LEVELS OF MEMBERSHIP
Platinum – $25,000 – all member benefits and one seat and two votes on the FAIR Fund Board of Directors
Gold – $15,000 – all member benefits, one seat, and one vote on the Board of Directors
Silver – $5,000 – all member benefits but no seat on the Board and no formal vote
“Every IRF leader I speak with is frustrated with the Medicare audit and appeals process, but too few IRF leaders put their money where their mouth is,” said Felice Loverso, President of the FAIR Fund and President and CEO of Casa Colina Hospital and Centers for Healthcare. “The FAIR Fund’s work benefits all IRFs and we need everyone to lend a hand so we are all pulling in the same direction. That’s the only way to help level the playing field on IRF audits and appeals.”
Privacy & Contribution Policy
If you choose to become a FAIR Fund member or simply make a donation, you will be asked to provide contact information and financial information (such as a credit card number and expiration date). This information is used for billing purposes and to process your payment. The FAIR Fund handles all of this data with confidentiality.
Any personal information provided to the FAIR Fund will not be traded, rented, sold or otherwise shared with anyone outside the organization, or used for reasons beyond those contemplated in this statement. From time to time, we may engage third parties to process your information on our behalf; however, none of the FAIR Fund’s affiliates (such as our credit card company) have permission to retain, share, store or use personal information for any reason other than processing the requested membership payment or donation.