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  • Clarification of Instructions Regarding the Intensive Level of Rehabilitation Therapy Services Requirements

Clarification of Instructions Regarding the Intensive Level of Rehabilitation Therapy Services Requirements

23 Feb 2018 11:59 AM | Zachary Edgar (Administrator)

Effective Date: 3/23/2018

The purpose of this Change Request (CR) is to clarify the instructions for conducting medical review of Inpatient Rehabilitation Facility (IRF) claims when reviewing the requirements for the intensive level of rehabilitation therapy services.

Contractors shall verify that the IRF documentation requirements are met in accordance with Pub 100-02, Medicare Benefit Policy Manual, Chapter 1, Section 110.

Contractors shall not make denials based solely on any threshold of therapy time.

Contractors shall use clinical review judgment to determine medical necessity of the intensive rehabilitation therapy program based on the individual facts and circumstances of the case.

Contractors shall not make denials solely because the situation/rationale that justifies group therapy is not specified in the patient’s medical records at the IRF.

Reference

Transmittal #R771PI

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