Inpatient admission criteria

[wscott]

Hi,

I am just getting started with inpatient rehab after not doing it for a while. Can anyone PM me some written criteria they use to accept inpatient rehab admits? What do you accept or not accept. This will be helpful for our admissions coordinator.
I am grateful for your help.

Thanks

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[lobelsteve]

Valid insurance and a heartbeat.

 

[Agraphia]

Hi Wscott.

-can your hospital manage the medical issues (wounds, trachs, etc)
-can they tolerate the 3 hours of therapy
-must have rehabilitation goals
-do they have a dispo after rehab

the liaison or hospital admin people will say exactly what Dr. Lobel said with a straight face

Hope this helps

 

[DMBandFan86]

Valid insurance and a heartbeat.

yay, then you get stuck with a hospice patient and have a bunch of family meetings, phone calls and goals of care discussions. Perfect for IPR.

 

[Punkn]

Medical necessity is key if they have therapy goals. No absolute criteria from CMS. I ask myself why do they need to be in a hospital? Why do they need 24/7 rehab nursing? Why do they need a doc most days a week who is changing their medical plan of care? Can any of that be met at a lower level of care (SNF, etc)? Do they have a realistic disposition plan for home?

 

[j4pac]

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Inpatient_Rehab_Fact_Sheet_ICN905643.pdf

Avoid Medicare fraud. PM&R physicians have lost their medical licenses for inappropriately admitting patients to IRF. And from what I understand...Medicare is becoming more and more vigilant every year.