IRF Services and Pre/Post-Admission Documentation

IRF providers are reminded that a preadmission screening of the patient's condition must be completed within 48 hours before the IRF admission to support coverage. The preadmission screening serves as the primary documentation by the IRF clinical staff of the patient's status prior to admission and of the specific reasons that led the IRF clinical staff to conclude that the IRF admission would be reasonable and necessary. As such, IRFs must make this documentation detailed and comprehensive.

The post-admission physician evaluation (PAPE) documentation requirement, previously required pursuant to 42 CFR § 412.622(a)(4)(ii), was removed in the FY 2021 IRF PPS Final Rule (85 FR 48424).

The PAPE is no longer required for discharges on or after October 1, 2020. However, the history and physical is still required under the Conditions of Participation at 42 CFR § 482.24(c)(4)(i)(A).

For the purposes of late-file claims with discharges prior to October 1, 2020, the PAPE would still be considered required documentation.

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Last Updated Fri, 05 Nov 2021 20:24:44 +0000