Inpatient Rehabilitation Facility (IRF)

An IRF is a hospital, or part of a hospital, that provides an intensive rehabilitation program to inpatients. Patients who are admitted must be able to tolerate an intensive level of rehabilitation services and benefit from a team approach. The IRF benefit is not to be used as a substitute to complete the full course of treatment in the referring hospital. A patient who has not yet completed the full course of treatment in the referring hospital is expected to remain there, with appropriate rehabilitative treatment provided, until the full course of treatment has been completed. The medical records must support that the documentation and criteria requirements are both met for the IRF stay to be considered medically reasonable and necessary.

On this page, view information about the below.

Preadmission Screening

A comprehensive preadmission screening process is the key factor in initially identifying appropriate candidates for IRF care. It must be conducted by qualified licensed or certified clinician(s) within the 48 hours immediately preceding the IRF admission.

The preadmission screening documentation must indicate the patient's prior level of function (meaning prior to the event or condition that led to the patient's need for intensive rehabilitation therapy), expected level of improvement, evaluation of the patient's risk for clinical complications and the expected length of time necessary to achieve that level of improvement.

Post-Admission Physician Evaluation

The purpose of the post-admission physician evaluation is to document the patient's status AFTER admission to the IRF, NOTE ANY DISCREPANCIES WHEN comparing to the patient's status documented in the preadmission screening documentation, and then begin developing the patient's expected course of treatment that will be completed with input from all of the interdisciplinary team members into the overall plan of care.

Individualized Overall POC

The individualized overall plan of care must be "individualized" to the unique care needs of the patient based on information found in the preadmission screening, the post-admission physician evaluation and what is collected in therapy assessments. THE INFORMATION MUST BE integrated by a rehabilitation physician to support a documented overall plan of care that is completed and signed within four (4) days of admission.

Physician Orders

The physician must generate orders to admit the patient into the IRF. The orders must be retained the patient's medical record at the IRF and meet the signature requirements in the CMS IOM, Publication 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.3.2.4

IRF-PAI

The CMS IRF Patient Assessment Instrument webpage contains:

  • Updated IRF-PAI Training Manual
  • System Maintenance and data transmission information

The IRF-PAI must be included in the patient's medical record either in electronic or paper format. The data collected on the IRF-PAI should correspond with the information in the patient's medical records at the IRF.

Resources

 

Last Updated Mar 23, 2018

The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.

IRF Medical Review Changes SE17036   Dec 12, 2017
IRF PPS FY 2018 Pricer Changes CR10125   Aug 30, 2017