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Written by: Darlene D'Altorio-Jones (1959-2015) on Monday, April 11, 2011 Posted in: Inpatient Rehab

How close are you to u201cpinpointingu201d the need for a rehabilitation level of care? Does your pre-admission assessment provide a quick snapshot of rationale? Being concise, yet thorough, is a tough act to train once youu2019ve been blindfolded and twirled into an entire lifeu2019s medical history or a copy of the acute medical record.

Pre-admission screens can be excessive. If a physician must review mounds of information, without easily finding their answers, it can be dizzying. Often times we hear physicians frustrated about information thatu2019s excessive and does not necessarily support the admission decision. Doctors need to hone in on the reason for the admit, given the right amount of information for the nine to ten elements required, so they can focus on pinning the tail on the pre-admission screen. Do they concur with the admission on not?

In past practice, it was acceptable that a denial could stand on the argument that a different level of care, such as skilled, was more fitting. This is no longer true. It is essential that a clinician gather information as though they were preparing legal defense with the most precise arguments toward each required element; describing the patient along with the reasons for the unique skills of the interdisciplinary rehab team led by the rehabilitation physician is key.

How do you get better at this? Do not skip outlined components and continue to randomly audit and train best practice to succinctly focus on the criteria. Focusing on the answer to each question is the first document that defines the skill required to care for the patient and leaves no question toward medical necessity and appropriate placement at a rehab level of care.

Pre-admission criteria:

  • Prior level of function (prior to the event that caused the need for rehabilitation)
  • Expected level of improvement
  • Expected length of time necessary to achieve level of improvement
  • Risk for clinical complications
  • Conditions that caused the need for rehabilitation
  • Combinations of treatments needed in the IRF
  • Expected frequency and duration of treatment in the IRF (Can the 3 hour rule be tolerated?)
  • Anticipated discharge destination from the IRF
  • Anticipated discharge treatments
  • Other information relevant to the patientu2019s care needs upon admission to the IRF

Finally, a review and concurrence of the findings by the rehabilitation physician to approve or deny the decision to admit is what pinpoints a successful pre-admission screen. This document and the timeframes required around it are the first defense against denial of coverage. In fact, some of the first reviews of 2010 guidelines are specific to physician component requirements. Information gathered is the foundation for building physician documentation post admission.