Wishing You and Your Family Happy Holidays!

To close out the year, we have provided you with a list of resources that provide the framework for inpatient rehabilitation facility (IRF) services. Each of the references has been hyperlinked to the full document described.

Regulatory Documents Updated for 2014 – 2015

• Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2015; Final Rule

• IRF-PAI Manual:  Effective October 1, 2014 (See reference list at bottom of page).
• Final IRF-PAI effective October 1 ,2014

• Final IRF-PAI effective October 1, 2015

Documents Related to the 1/1/2010 Requirements

• Medicare Benefit Policy Manual, Chapter 1 – Inpatient Hospital Services Covered Under Part A
  Section 110 – Inpatient Rehabilitation Facility Services includes the detailed information about Preadmission Screening (PAS), Post Admission Physician Evaluation (PAPE), Individualized Overall Plan of Care (IPOC), Admission Orders, Team Approach, Intensity of Therapy and Medical Necessity (Reasonable and Necessary Care)
  

• http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/InpatientRehabFacPPS/Downloads/IRF-Training-call_version_1.pdf
  Provides clarifications about documentation requirements in the PAS, PAPE, IPOC, Admission Orders, and inclusion of the IRF-PAI in the record with corresponding date and time.

• http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/InpatientRehabFacPPS/Downloads/IRF-Training-call_version_2.pdf
  Provides clarifications about the use of multiple therapy disciplines, group therapy, intensity of therapy, adjunct therapies, medical necessity, rehabilitation nursing requirements, the elimination of trial therapy, and breaks in therapy.

• www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/InpatientRehabFacPPS/Downloads/IRF-Training-call_version_3.pdf
  Provides clarifications about a number of topics including the brief exceptions policy for therapy, weekly team meetings, post-admission physician evaluation time frames, and the ability to “make up” therapy minutes.

• http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/InpatientRehabFacPPS/Downloads/IRF-Training-call_version_4.pdf
  Provides additional clarifications about admissions orders, the PAS, the PAPE and therapy requirements.

Other Helpful Links

• Medicare Claims Processing Manual, Chapter 3 – Inpatient Hospital Billing
  Section 140 – Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) includes detailed information about classification and payment requirements. This section covers the details of the CMS-13 requirements including those for arthritis.

• CMS.gov Home Page for Inpatient Rehabilitation Facility PPS
  This link takes you to the home page for CMS regulations for IRFs.

About the Author

Angela M. Phillips, PT, is president and chief executive officer of Images & Associates.  A graduate of the University of Pennsylvania, School of Allied Health Professions, she has more than 35 years of experience as a consultant, healthcare executive, hospital administrator, educator and clinician.  Ms. Phillips is one of the nation’s leading consultants assisting Inpatient Rehabilitation Facilities in operating effectively under the Medicare Prospective Payment System (PPS) and in addressing key issues related to compliance.

Contact the Author

angela.phillips@att.net

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