There is much work that goes into the pre-admission screen and the specificity required to make a solid decision for appropriateness to admit.
And yet with so much information, what are the other important elements to defend a solid case of medically necessary care at an IRF?
Two things that come to my mind are the time required to fulfill the needed proposed plan of care and the time reasonably available at a SNF level of care within my immediate practice surroundings.
Given those two items, you may change how the physician “summarizes” and “concurs” with the appropriateness for admission to your IRF.
How clever would a summary statement that states, ”based on the pre-admission screen and the information provided, medical management and clinical contact care would take no less than five hours per patient day to fulfill the plan of care established to manage this patient’s needs for both medical and functional retraining. These needs are in addition to the three hours required for therapy intensity. Given these totals, the care specifically surpasses skilled standards that average closer to two hours of clinical contact care.” Make sure you know the standards in your state, and more specifically in your practice area as noted on the CMS Compare website.
See a detailed discussion on this topic that will make your decision to admit more audit proof HERE.