Inpatient rehab under a consultant model

[RodofEbullience]

I've seen some independent contractor inpatient rehab positions (including with Encompass) advertised which have PM&R as consultants and Internal handling "attending duties". So with this model, IM does all admissions/bills 99223? And PM&R only bills for initial consults? And would PM&R still see the patients daily or is only IM expected to? How does this differ in terms of reimbursement when compared to models where PM&R is the primary attending?

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[Issa_Mithras]

I work under this model.

IM is the attending of record, puts in admit orders, and is primary on call. I believe they are strongly encouraged to get their admission H&P in under 24-48hrs. They are 1st contact for nurses for most issues. They make the call to transfer patients to acute. I don’t believe there are any strict guidelines to how often they need to see the patients, but usually they are employed by a physician staffing company that has them swing the patients daily. Usually 7 on, 7 off. They are responsible for discharge summaries.

CMS mandates that any IRF has a “rehab physician” that is the only one who can do the following duties:

1. Sign pre-admission screens
2. Complete rehab H&P within 24hrs that outlines the rehab necessity and care plan (called a “consult” when medicine is primary and does the formal H&P)
3. Sign IPOC by day 4 of admission
4. Complete 3 face-to-face visits per week that evaluates the patient medically and functionally.
5. Personally attend and sign off on weekly team conference.

Very vague guidelines on how many different specialities can see and bill for a patient visit per day. Must be “medically necessary”. Sometimes you have PM&R and IM seeing each seeing the patient every day, though that’s likely overkill and may raise red flags. Completely normal to see situation where IM sees patient 7 days a week and PM&R sees them 5-6 times per week.

Both IM and PM&R can bill 99222/99223 on the same patient because they are different specialities. Just like they can both bill 99232/99233 on the same day. You just have to document/demonstrate medical necessity, which again is very vague.

 

[Iamnew2]

I work under this model.

IM is the attending of record, puts in admit orders, and is primary on call. I believe they are strongly encouraged to get their admission H&P in under 24-48hrs. They are 1st contact for nurses for most issues. They make the call to transfer patients to acute. I don’t believe there are any strict guidelines to how often they need to see the patients, but usually they are employed by a physician staffing company that has them swing the patients daily. Usually 7 on, 7 off. They are responsible for discharge summaries.

CMS mandates that any IRF has a “rehab physician” that is the only one who can do the following duties:

1. Sign pre-admission screens
2. Complete rehab H&P within 24hrs that outlines the rehab necessity and care plan (called a “consult” when medicine is primary and does the formal H&P)
3. Sign IPOC by day 4 of admission
4. Complete 3 face-to-face visits per week that evaluates the patient medically and functionally.
5. Personally attend and sign off on weekly team conference.

Very vague guidelines on how many different specialities can see and bill for a patient visit per day. Must be “medically necessary”. Sometimes you have PM&R and IM seeing each seeing the patient every day, though that’s likely overkill and may raise red flags. Completely normal to see situation where IM sees patient 7 days a week and PM&R sees them 5-6 times per week.

Both IM and PM&R can bill 99222/99223 on the same patient because they are different specialities. Just like they can both bill 99232/99233 on the same day. You just have to document/demonstrate medical necessity, which again is very vague.

I worked at a place where IM would do both IM and was "double credentialed"as "rehab physicians"