A Single Solution to 3 Common Sources of Denial in Inpatient Rehab
It’s probably no surprise to inpatient rehab providers that the level of scrutiny from auditors has intensified in the last few years. Unfortunately, with CMS’ movement toward a single payment model for all post-acute care, the scrutiny is likely to get worse before it gets better.
Therefore, inpatient rehab facilities (IRF) have to be absolutely sure that every compliance detail is attended to properly—with no margin for error. Even the tiniest deviation from just a single coverage guideline can mean that your reimbursement for each patient’s entire stay is denied. Managing it all, obviously, is a tremendous challenge, but there are tools to help—some of which are designed specifically to address three of the critical, high-value IRF workflows that are commonly associated with denials.
Often, the unwavering timelines, particularly of the pre-admission process, can be the most difficult to meet. But if you have an IRF-specific software solution, your clinical liaisons can take advantage of forms and templates that help them speed through the pre-admission process. And time stamps and alerts keep them moving toward meeting the 48-hour pre-admission deadline. Of course, gaining physician approval within the pre-admission time frame sometimes presents problems, but enabling your rehab doctors to review and approve on the go, which requires a specialized mobile notification system, can prevent delays.
Ensuring that patients receive the required 3 hours of therapy per day at least 5 days per week—or at least 15 hours of intensive rehabilitation therapy within a 7-consecutive-day period—is tough to manage on paper or with static white boards. And often, therapists are scrambling at the end of the week to make up missed therapy minutes—or hours. However, with an automated scheduling system built specifically for IRF needs, your team can plan the total therapy time in advance and monitor deviations every day. That way, when adjustments are required for compliance, they can be minor tweaks rather than major changes.
IRF-PAI and quality measures
With the current IRF-PAI—which now includes more than 300 pieces of data that have to be collected—there’s no doubt that an automated system designed to assist with its completion is a valuable asset. And, of course, accurate data capture is critical to your reimbursement.
While automated assistance with the IRF-PAI helps ensure accuracy and minimize denials now, there are longer term implications as well because the data being gathered now may be setting your IRF up for lower reimbursements later. Therefore, you have to be absolutely certain that the data you provide is accurate.
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Specifically, you have to ensure that your IRF can:
- Complete all FIM™ scoring in a reliable, duplicatable, and defendable fashion
- Collect and report data for quality measures
- Automate submissions to benchmarking services such as UDS and eRehab so that no inefficient and error-prone manual data entry is required
- Be prepared for every change that CMS has in store every year and adapt your processes to ensure compliance
With the right IRF management tool, you can easily and effectively address all four of these critical IRF-PAI and quality measures issues. In fact, there’s one IRF tool, MediLinks IRF Management, that can help you resolve common IRF compliance issues, from pre-admission screening through treatment and IRF-PAI completion. For more information about MediLinks IRF Management, go to Mediware.com/IRF.