Did You Know? – Inpatient Rehabilitation Facility (IRF)
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- Please clarify the start and end time when coding for concurrent or group therapy on the IRF PAI.
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When conducting concurrent and group therapy sessions, start and end times do not need to be the same for all of the patients that are participating. The exact time spent for each individual participating in a concurrent or group therapy session should be reported as such. Any additional one-on-one therapy time spent with an individual either, prior to or following participation in a group or therapy session, should be recorded as individual therapy.
Reviewed 12/01/2022
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- What is an IRF?
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IRFs are free-standing rehabilitation hospitals and rehabilitation units in acute care hospitals.
Reference:
Reviewed 12/01/2022
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- How are IRFs paid?
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These facilities are exempt from the Hospital Prospective Payment System (PPS) and are paid under the IRF PPS system. In order to be paid under the IRF PPS, they must submit the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI).
Reference:
Reviewed 12/01/2022
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- We are getting an IRF-PAI submission edit, 37096. How do we correct it?
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IRF claims submitted to FISS will suspend to status/location SMFRX0 with reason code 37096. FISS then communicates with the CMS National Assessment Collection Database to request a match of the claim with the assessment. Each nightly cycle, the status/location changes the last digit until four nightly cycles are completed (SMFRX0 - SMFRX4).
If no return file is received after the fourth nightly cycle, the claim will Return to Provider (RTP) with reason code 37096. Instructions for correcting these claims can be found in the CGS article titled, "Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF - PAI)"
Reviewed 12/01/2022
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