CMS-13
What is the 60% 40% rule
CMS requires 60% of our patients be CMS compliant and the 40% can be any diagnosis
Patient comes in after being found down, has generalized weakness, requires min- mod A for mobility and diagnosed with Rhabdomyolysis. What is the RIC?
No, Rhabdomyolysis is not a qualified neuro diagnosis, the appropriate RIC is other.
How many therapy disciplines are required for a patient to qualify for IRF?
2 hours
Are all Neuro RICs CMS-13?
No, not all neuro diagnoses are CMS compliant; ext lumbar surgery with radiculopathy= neuro diagnosis, but typically not coded out as CMS.
Patient comes in with confusion, multiple falls with head strike w/ LOC, UTI, Name that RIC
TBI
How many hours of therapy do patients received at IRF vs SNF?
3 hours; vs Florida average of 14 mins at a SNF
Who is responsible for sending the prescreen to the physician?
Admissions liaison
What are the 13 CMS categories?
Stroke, SCI, Congenital deformity, Amputation, MMT, Hip fracture, TBI, Neurological, Burns, Arthritis,
Systemic Vasculitis , Joint replacement
Bilateral pubic rami fracture with disruption of the pelvic ring; Name that RIC
Hip fracture
What are the conditions for a joint replacement to qualify for CMS?
BMI >50, age > 85y/o or Bilateral joints
Metabolic encephalopathy; patient is alert and oriented x3 and being treated for AKI, generalized weakness and chronic CHF
RIC: NTBI, BUT it may not code out as CMS due to the patient being alert and oriented.
What are the 5 Medicare criteria for IRF admisison?
Must require multiple therapy disciplines, must require intensive rehab, be reasonably expected to benefit significantly from IRF, require supervision from a rehab physician at least 3x/wk, and require intensive and coordinated interdisciplinary team approach.