Admit One
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Potpourri
100
This is a comprehensive process for initially identifying appropriate candidates for IRF care.
What is: preadmission screening?
100
Timely preadmission screening must be conducted within these hours preceding the IRF admissions.
What is: 48 hours?
100
The complexity of a patient’s nursing, medical management, and rehabilitation needs requires what type of approach to care.
What is: interdisciplinary?
100
This must be individualized to the unique care needs of each patient.
What is: the plan of care?
100
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?
200
The preadmission screening may be conducted in-person or through a review of this (if IRF is preceded by a hospital stay).
What are: hospital medical records?
200
IRFs typically provide this many hours of therapy per day.
What is: 3 hours?
200
This person must lead the interdisciplinary team meeting, even if not physically present at the meeting.
Who is: the rehab physician?
200
The plan of care must be completed within this timeframe.
What is: within 4 days of admission?
200
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?
300
This person reviews and documents his or her concurrence with the findings and results of the preadmission screening.
Who is: the rehab physician?
300
Required therapy treatments must begin within how many hours within midnight of the day of admission to the IRF.
What is: 36 hours?
300
Other than the Rehab Physician, these other participants are required at the interdisciplinary team meeting.
Who is: a social worker, RN with specialized training or experience in rehabilitation, and a licensed or certified physical therapist, occupational therapist, and speech-language pathologist (to the extent that each of these particular disciplines is involved in the patient’s care).
300
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?
300
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?
400

Preadmission screening documentation should not be presented primarily in this format.

What is: "check-off" boxes?

400
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?
400
The periodic team conferences—held a minimum of once per week—must focus on these four things:
What are: 1. Assessing the individual's progress towards the rehabilitation goals; 2. Considering possible resolutions to any problems that could impede progress towards the goals; 3. Reassessing the validity of the rehabilitation goals previously established; and 4. Monitoring and revising the treatment plan, as needed.
400
This person is responsible for the overall plan of care.
Who is: the rehabilitation physician?
400

A beneficiary’s need for this is not an IRF coverage criteria, and may not be used in determining whether an IRF claim is reasonable or necessary.

What is: 24-hour rehabilitation nursing?

500
These individuals conduct the preadmission screening and must write out the detailed reasoning/justification for the IRF admission.
Who are: licensed or certified clinicians?
500
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?
500
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.
500
The plan of care is based on information from the pre and post admissions evaluations, as well as information garnered from these assessments.
What are: therapy assessments?
500

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: False.

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