The FAIR Fund, or the Fund for Access to Inpatient Rehabilitation, is a common legal defense fund comprised primarily of inpatient rehabilitation hospitals and units that have organized to bring legal challenges to overly restrictive interpretations of medical necessity 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 rehabilitation. Members and supporters of the Fund believe that exercising the legal rights of providers is a necessary strategy to challenge the restrictions in access to inpatient medical rehabilitation that the Centers for Medicare and Medicaid Services (CMS) and its contractors have systematically pursued in the recent past. Through legal challenges, the FAIR Fund will attempt to establish precedent-setting decisions with widespread application at the federal court level that will clarify medical necessity requirements for inpatient medical rehabilitation and ensure that Medicare contractors use proper procedures when reopening claims.
The Steering Committee is the governing body of the FAIR Fund. An inpatient rehabilitation hospital or unit that joins the FAIR Fund may elect to join the Steering Committee and receive two votes with an initial pledge of $25,000. A member may also join the Steering Committee with one vote with an initial pledge of $15,000. Members may combine resources at a minimum of $5,000 per facility for one or two votes on the Steering Committee. Of course, contributions at ANY level are welcome and encouraged. Every little bit counts.
A contribution to the FAIR Fund of $5,000 or more permits the member to access appeal templates for each stage of administrative appeal and other documents supporting the medical necessity of inpatient rehabilitation care. These documents may be used by FAIR Fund members as they appeal their own claim denials. Fund attorneys developed these documents based upon their extensive experience appealing inappropriate medical necessity denials around the country. These documents will be important tools to strengthen the ability of members to challenge inappropriate medical necessity denials.
If you don't have a FAIR Fund account, please click on Create an Account at the top of this page and join us in this effort.