Inpatient rehabilitation facility quality reporting program. Tricare program manuals 2015 edition t2017 tricare operations manual 6010. J15 part a faqs inpatient rehabilitation facility irf. Inpatient rehabilitation facility irf pai providers inpatient rehabilitation facility irf pai providers the purpose of this page is to display technical information related to irf pai the inpatient rehabilitation facility patient assessment instrument data set for use in inpatient rehabilitation facilities.
Irf pai training manual fy 2018 rf pps final i rule update irf pai training manual to include changes to irf. Pra reports clearance officer, mail stop c42605, baltimore, maryland 212441850. Each of these areas will have updated information that must be followed when completing irf pai data for all patients discharged after oct 1, 2015. Licenses and notices license for use of physicians current procedural terminology, cpt fourth edition. The years listed reflect the most recent full year available from the ccw. This video from the irf qrp provider training held may 18 and 19, 2016, provides guidance on section h of the irf pai v1. Measurement scale, impairment codes, and refinements thereto for the irf pai, and for the guide for the uniform data set for medical rehabilitation, as incorporated or referenced herein. Updated sections of the irf pai manual effective date 1001 2015 are in a zip file here click here for the inpatient rehab facility patient assessment instrument manual effective date 10012012 click here for the inpatient rehab facility patient assessment instrument manual effective date 4012004. We are actively responding to all phone and email inquiries. It can be a challenge due to medicare inpatient rehabilitation facility prospective payment system irf pps. Irfpai inpatient rehabilitation facility patient assessment irfpai. Irf quality reporting archives cms main navigation. Irf coding inpatient rehabilitation facility coding.
Inpatient rehabilitation facility irf pai vendors the purpose of this page is to display technical information related to irf pai software jirven. Discuss changes to the irf pai manual that coincide with the. Cms memorandum on inpatient rehabilitation facility irf prospective payment. Then put those rules behind you and begin anew with these updates to your manual. The video slideshow of the presentation is now available in the related links section below. This version of the irfpaibased user s manual is effective on october 1, 2019 and provides detailed information for each quality measure, including quality measure definitions, inclusion and exclusion criteria, and measure calculation specifications.
The pas tool is designed to satisfy the requirements for preadmission screening documentation outlined in the 2010 irf pps final rule and in the 2010 revisions to the medicare benefit policy manual. The information provided in the pai is as critical as the care provided. Cms held an mln connects national provider call on january 15, 2015 to train irf industry providers on recent changes to the irfpai training manual regarding the arthritis attestation item 24a and therapy information section items o0401 and o0402. Updated irfpai training manual section 2 item by item irf pai coding instructions updated to include changes that will be effective october 1, 2017 as finalized in the fy 2018 irf pps final rule. The inpatient rehabilitation facility irf patient assessment instrument pai is the assessment instrument irf providers use to collect patient. File your 2015 cases with discharges up through september 30th. The functional independence measure fim, on which it is largely based, was developed prior to that, as a standardized way of measuring the progress of. Inpatient rehabilitation facility irf patient assessment instrument pai manual. Irfpai therapy information data collection mln connects. Et, the quality improvement and evaluation system qies dear irf provider, as of october 1, 2019, the inpatient rehabilitation facility patient assessment. Medicare advantage populations combined are at least 50 percent of its total inpatient population and the irf pai data records support that at least 60% of the submitted assessments met the eligibility requirements presumptive methodology, then the irf is presumed to have met the requirements to continue to be paid as an irf. Cms medicare learning network, medicare outpatient therapy billing and part b billing scenarios for pts and ots cms inpatient rehabilitation facility followup series 14 cms mln connects national provider call on 11515, irf pps.
Irfpai training manualeffective2004 pdf irfpai jan. This version is essentially the same as the previously posted 1. New irf pai items effective october 1, 2015 mln connects call 011515. Therefore, in regards to who must have responsibility for the irf pps, generally, the person called the irf pai coordinator must meet these requirements. Irf pai training manual revised 011602 the process of taking a wellknown clinical tool and making it the basis of a national prospective payment system. Errata for irfpai training manual effective october 1, 2015 available in the. Inpatient rehabilitation facility patient assessment. The medical record indicates the patient was admitted to the irf january 1, 2015 at 6. The revised manual, attached, offers instructions for completing irf pais submitted on or after oct. Minimum system requirements for home health agencies, hospice providers, long term care facilities, inpatient rehabilitation facilities and long term care hospitals. Tricare manuals display tr15 chap 17 sect 1 inpatient. Inpatient rehabilitation facility irfpai providers cms.
Irfs shall use the cms irf pai as specified in 42 cfr 412. Irf referral decision tree a quick visual guide to assist the case manager in determining whether or not to refer. This measure was finalized in the fy 2015 irf final rule which was. Inpatient rehabilitation facility reference booklet. On june 3, 2019, cms sent an email to effective september 27, 2019 at 5. Irf pai inpatient rehabilitation facility patient assessment instrument. The quality improvement and evaluation irfpai validation utility tool vut v1.
Cms training call describing the new irf coverage requirements. Inpatient rehabilitation facility patient assessment instrument irfpai. A question and answer session will follow the presentation. The medical record did not include a completed irf pai form.
If the irf pai is transmitted more than 27 calendar days from and including the date the beneficiary is discharged, the irf s payment rate for the applicable casemix group will be reduced by 25 percent. Each of the above must have current knowledge of the patient as documented in the medical record at the irf. Irf coding for icd10 and the tricky seventh character. Who must coordinate the collection of the irf patient. The irf pai manual references these definitions for coding the irf pai in section ii. The instructions outlined in the fy 2015 irf pps final rule regarding use of the seventh character in the irf setting apply to reporting on the irf pai only. Although cms published the event as the 2015 irf pai, the irf pps fiscal year always begins on october 1. All medicare transactions for all dates of service must be submitted with the mbi. In the fy 2015 inpatient rehabilitation facility irf prospective payment system pps final rule, cms finalized two new items on the irf patient assessment instrument pai, an arthritis. The anatomy of a rehab patient this slide presentation may be used to train hospital case managers on which patients should be referred to the irf. Her global perspective, clarity of thought, and emphasis on the importance of the research findings has ensured that the system will be of the highest quality.
Cms internet only manual 2 medicare benefit policy manual, chapter 1 inpatient hospital serves covered under part a, section 110. Inpatient rehabilitation facility patient assessment instrument irf pai page. Please note that the irfpai manual replaces previous versions of the. I would print and staple the january clarification to the manual until a matching manual definition is published at cms. The itc meetings were held on january 3, 2015, january, 2015, and january 17, 2015. Irf pps requires completion of the irf patient assessment instrument pai, a data collection form completed. The accuracy and thoroughness of the specific data recorded on the irf pai, including cms quality measures b. Overview of irf qrp and changes to the irfpai version 3. In light of the evolving covid19 situation, we want to assure you that resdac remains open for business. This release is effective on torrance, ca qies west site will be. Data dictionary for inpatient rehabilitation facility irf.
Patients who are admitted must be able to tolerate an intensive level of rehabilitation services and benefit from a team approach. Inpatient rehabilitation facility irf an irf is a hospital, or part of a hospital, that provides an intensive rehabilitation program to inpatients. The irf can then make an assessment as to whether or not the patient meets admission requirements. Sections of the irfpai training manual effective oct 1, 2015 zip. Irfpai assessment data from cms can typically be requested within three months of the. Dear inpatient rehabilitation facility irf provider.
For more information on the data sets and quality reporting requirements, please reference the irf pai and section 4, the quality indicator section of the irf training manual, located on the irf pai and irf qrp manual webpage. This page will be updated when an update is made to these resources, a newer version becomes available. Irf patient assessment instrument irf pai included in patients medical record must be dated, timed and authenticated by person responsible for providing or evaluating service provided either in a cover page or handwritten somewhere on form. Cms is looking specifically at the cost of postacute care and how patients admitted to and discharged from irf s are utilizing resources associated with the medicare trust fund. The 2016 fiscal year that begins october 1, 2015, has a medlearn matter training event scheduled to prepare you for the irf pai that will be utilized next october. The irf pai was created for use by facilities subject to cms s payment system for medicare inpatient rehabilitation services. Any reference to the fy 2015 irf pps final rule in this final rule also includes the. How they are used and how you can be involved duration. Inpatient rehabilitation facility patient assessment instrument irf pai the irfpai is used to gather data to determine the payment for each medicare part a feeforservice and medicare part c medicare advantage patient admitted to an inpatient rehabilitation unit or. Inpatient rehabilitation facility irf coding can be a challenge due to the medicare inpatient rehabilitation facility prospective payment system irf pps, which was implemented in 2002 to cover patients paid under medicare part a. More information about irf compare can be found by visiting the cms. Ensure that the record includes a completed irf pai form. This statement applies to the 2015 release of the irfpai version 1.
Hart hospice abstraction reporting tool is a java based software application that provides an option for hospice facilities to collect and maintain facility, patient and his record information for subsequent submission to the appropriate national data repository. Cms posts clarifications to newly added irf pai sections. Facility irf quality reporting program qrp provider training on held august 15 and 16. The purpose of the irfpai manual is to offer continuing guidance to irfs regarding data collection, submission, and reporting.
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