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Written by: Darlene D'Altorio-Jones (1959-2015) on Sunday, July 22, 2012 Posted in: Inpatient Rehab
Some of our clients believe that Length of Stay (LOS) is calculated by admit to discharge date of an IRF stay regardless of what happens in between that stay. Of course, if there are no interruptions that is the case.  The admission day is counted but the discharge date is not.


When an IRF stay has interruptions, despite requiring one IRF-PAI for the entire stay, the next question is, “What is the LOS day count when a patient had an interrupted stay?”  Given the confusion, I consulted with CMS asking,  ”Is LOS count a pure admit to discharge calculation, or is it reduced by days away when interrupted stays occurred?”

Susan Seagrave provided this reference in an email on Sept. 16, 2011:

“I was just reading through one of the sections of our IRF manual (Chapter 3, Section 140.2.3 of the Medicare Claims Processing Manual (Pub. 100-04)) and came across the following guidelines regarding the LOS calculation: ‘Interrupted stays are defined as those cases in which a Medicare beneficiary is discharged from the inpatient rehabilitation facility and returns to the same inpatient rehabilitation facility within three consecutive calendar days. The three consecutive calendar days begin with the day of the discharge from the IRF and ends at midnight of the third day. The length of stay for these cases will be determined by the total length of the IRF stay including the days prior to the interruption and the days after the interruption.’

I wanted to let you know, because this is the reference that you can provide people for the fact that we only include the days that the patient is actually in the IRF in the LOS calculation.’’

—Susanne Seagrave, Ph.D.,  Inpatient Rehab Team Lead, CMS/CMM/CCPG/Div. of Institutional Post Acute Care

I believe the information found in the online manual clarifies that LOS cannot be determined solely by the admit and discharge date.  It is important that days away are subtracted from the total for accuracy, specifically if discussing outcomes, as those are the actual days the patient was available in the IRF to receive the care your team has provided.  These exception days are reflected under item area 43 of the PAI document. How does this affect the expected 15 hours for the patients current seven day cycle?