Inpatient Rehab Facility (IRF) – EMR Documentation Design Series

Beyond the inherent hurdles of change management and adopting electronic medical records (EMRs), Inpatient Rehabilitation Facilities (IRFs) also have many unique documentation needs. Although stand alone rehabilitation-specific electronic documentation systems are available, their overall cost and lack of integration capabilities make many products poor candidates for inpatient health care facilities with an existing EMR. Many IRFs must leverage the flexibility of their specific EMR to meet their documentation needs.

In this series, we’ll discuss some of the strict IRF regulatory guidelines set by Centers for Medicare and Medicaid Services (CMS) and ways to leverage the flexibility of an existing EMR to effectually address these challenges.

History

Medicare was created by the Social Security Act of 1965. This law established payments to hospitals for the reasonable costs incurred in the provision of care to Medicare beneficiaries. The Social Security Amendments in 1983 established a prospective payment system (PPS) to reimburse the costs of Medicare inpatient hospital stays based on the patient’s diagnosis or DRG. To account for diagnoses that resulted in extended or more costly lengths of stay, a small number of specific care facilities were exempted from the DRG requirement including children’s hospitals, psychiatric facilities, long term care facilities, and rehabilitation facilities.

IRF Admissions

Rehabilitation facilities that meet strict CMS requirements can earn the IRF designation, maintain their Diagnosis Related Group (DRG) exemption, and receive higher reimbursement for services provided under the Inpatient Rehabilitation Facility – Prospective Payment System (IRF-PPS). At least 60% of patients admitted into the IRF must have one of the following as a primary or secondary diagnosis that would benefit from IRF care:

• active polyarticular rheumatoid arthritis
• amputation
• brain injury
• burns
• congenital deformity
• femur fracture (hip fracture)
• hip or knee replacement
• major multiple trauma
• neurologic disorders
• osteoarthritis or degenerative joint disease
• spinal cord injury
• stroke
• systemic vasculidities with joint inflammation

CMS also requires that the patient be: (a) medically stable, (b) require the services of at least two acute rehabilitative therapies – physical, occupational, or speech, (c) able to tolerate at least three hours of intensive rehabilitative therapies per 24 hour period for at least five days per week, and (d) able to make measurable improvement to the patient’s functional capacity or adaption to impairments.

The Inpatient Rehabilitation Series continues here:

Part 2 – Pre-Admission Screen

Part 3 - Inpatient Rehabilitation Facility – Patient Assessment Instrument (IRF-PAI)

Part 4 – Functional Independence Measure (FIM)

Part 5 – Interdisciplinary Documentation – Plan of Care & Team Meetings

Part 6 – Physician & Nursing Documentation

Part 7 – PT, OT, SLP, Orthotics/Prosthetics Documentation

Part 8 – Other Services Documentation

Part 9 – The 3 Hour Rule