Healthcare It Squad

Fear not my friends – officially, there is no “3 Hour Rule”. However, CMS guidelines state that intensive rehabilitation services are generally recognized as “at least three hours of therapy per day at least five days per week” from the combination of core therapy disciplines (OT, PT, Speech Language Pathology or Orthotics/Prosthetics).
The week is defined as a rolling seven day period using the day of admission as day one. CMS does provide special concessions for medical necessity by allowing flexibility in the actual delivery of the 15 hours of intensive therapy …

While CMS does recognize the value of psychological, neuropsychological, recreational therapy, music therapy, and/or respiratory therapy services on a patient-by-patient basis; these services should only be used adjunct to the primary IRF therapies (PT, OT, SLP, Orthotics/Prosthetics) and are not included in the IRF-PPS payment. These services can be covered by Medicare if medical necessity is well documented by the rehabilitation physician and is ordered as part of the overall plan of care for the patient. The documentation design for these groups should meet individual practice guidelines, but does …

To meet IRF admission requirements, the patient must require therapy from at least two of the four core therapies: Occupational Therapy (OT), Physical Therapy (PT), Speech-Language Pathology (SLP), and/or Orthotics/Prosthetics. One of the two necessary therapies must be PT or OT.
Initial Eval
Upon admission to the IRF, one of the core therapies must conduct an initial evaluation and provide intensive therapy within 36 hours from midnight on the day of the patient’s admission. For example, if the patient is admitted at 3pm on Friday, the patient must be evaluated and intensive …

Rehab facilities must clearly demonstrate an interdisciplinary approach in the provision care. According to the CMS, IRF services must “be ordered by a rehabilitation physician with specialized training and experience in rehabilitation services and be coordinated by an interdisciplinary team, including at least a registered nurse with specialized training or experience in rehabilitation; a social worker or case manager (or both); and a licensed or certified therapist from each therapy discipline involved in treating the patient.” It is imperative for the informatician to understand the documentation requirements of each specialty …

Rehab facilities must clearly demonstrate an interdisciplinary approach in the provision care. According to the CMS, IRF services must “be ordered by a rehabilitation physician with specialized training and experience in rehabilitation services and be coordinated by an interdisciplinary team, including at least a registered nurse with specialized training or experience in rehabilitation; a social worker or case manager (or both); and a licensed or certified therapist from each therapy discipline involved in treating the patient.”12 It is imperative for the informatician to understand the documentation requirements of each …