Admit One
This is a comprehensive process for initially identifying appropriate candidates for IRF care.
What is: preadmission screening?
Timely preadmission screening must be conducted within these hours preceding the IRF admissions.
What is: 48 hours?
The complexity of a patient’s nursing, medical management, and rehabilitation needs requires what type of approach to care.
What is: interdisciplinary?
This must be individualized to the unique care needs of each patient.
What is: the plan of care?
Patients must be able to fully participate in and benefit from an intensive rehab therapy program at this time.
When is: prior to transfer from the referring hospital?
IRFs typically provide this many hours of therapy per day.
What is: 3 hours?
These include the preadmission screening, post-admission physician evaluation, individualized plan of care, physician orders, and the IRF PAI.
What are: the IRF documentation requirements?
This person reviews and documents his or her concurrence with the findings and results of the preadmission screening.
Who is: the rehab physician?
Required therapy treatments must begin within how many hours within midnight of the day of admission to the IRF.
What is: 36 hours?
The plan of care should include the intensity of therapy, the frequency of therapy, as well as this.
What is: the duration of stay/total number of days during the stay?
Stating that a patient could have been treated in this is never an acceptable justification for an IRF claim denial.
What is: a less-intensive setting?
True or False: The preadmission screening serves as the primary documentation of the patient status prior to admission to the IRF.
What is: True?
In order for the IRF stay to be considered reasonable and necessary, the post admission evaluation to verify that the patient’s status remains unchanged from the preadmission screening must be performed within this timeframe.
What is: within the first 24 hours of admission?
This person is responsible for the overall plan of care.
Who is: the rehabilitation physician?
The beneficiary must meet the general requirements of an intensive rehab program by meeting one of the criteria prior to admission to the IRF?
What is: 1)complex and coordinated therapy plan of care, with routine medical management? 2)Complex medical management, with a noncomplex therapy plan of care? 3)Complex medical management with a complex and coordinated therapy plan of care?
These individuals conduct the preadmission screening and must write out the detailed reasoning/justification for the IRF admission.
Who are: licensed or certified clinicians?
This is the minimum amount of times per week that the rehab physician needs to conduct a face-to-face assessment with the patient?
What is: 3 days per week?
In issuing an IRF claims denial, contractors should clearly note where those claims fail to meet one or more of the 5 coverage criteria, which are:
What is: 1. Patient requires multiple therapy disciplines 2. Patient requires an intensive rehabilitation therapy program 3. Patient can actively participate in, and benefit from, an intensive rehabilitation therapy program 4. Patient requires close medical supervision by a rehabilitation physician, as demonstrated by the need for face-to-face visits at least 3 days per week 5. Patient requires an interdisciplinary approach to care.
True or False: The post-admission physician evaluation can serve as one of the 3 required face-to-face rehab physician visits in the first week.
What is: True