35+
Years of Expertise
1989
Serving Healthcare Since
U.S.
Based, Credentialed Staff
All
Facility Types Served

Overview

Where Documentation Determines Eligibility

Inpatient rehabilitation facilities operate under some of the most specific documentation requirements in healthcare. Admissions must meet medical-necessity criteria for intensive rehabilitation, the preadmission screening and individualized plan of care must be complete, and the IRF Patient Assessment Instrument (IRF-PAI) must be accurate — or reimbursement and compliance are both at risk.

HMI’s specialists perform comprehensive medical-record reviews that confirm IRF admissions were appropriate to meet medical necessity and that documentation and staff services satisfied the minimum CMS requirements — from the physician admission order through the interdisciplinary team process.

The Challenge

What Inpatient Rehab Facilities Are Up Against

Medical-Necessity for Intensive Rehab

Each admission must be documented to support the need for intensive inpatient rehabilitation under CMS criteria.

IRF-PAI Completeness

The IRF Patient Assessment Instrument must be accurate and complete to support correct payment.

Required Documentation Elements

Preadmission screening, physician admission order, history and physical, individualized plan of care, and team meetings all must be in place.

Audit Exposure

Missing or incomplete required elements are a frequent source of denials and audit findings for IRFs.

We have utilized HMI since 2002 for consultation services, and have always found their services to be professional in nature and valuable to our organization.

David AlleyChief Financial Officer · Star Regional Medical Center, Athens, TN

Frequently Asked Questions

Inpatient Rehab Facilities, Answered

What does an IRF records review include?
Our specialists perform a comprehensive review of the patient medical record to confirm IRF admissions were appropriate to meet medical necessity and that documentation and staff services satisfied the minimum CMS requirements — including the preadmission screening, physician admission order, history and physical, individualized plan of care, interdisciplinary team meetings, and the IRF-PAI.
Do you check the IRF-PAI?
Yes. Confirming the completeness and accuracy of the IRF Patient Assessment Instrument is part of our review.
Can you help reduce IRF denials?
Yes. By confirming the required documentation elements and medical-necessity support up front, we help reduce the gaps that drive denials and audit findings.
Are your reviewers credentialed?
Yes. Every HMI specialist is 100% U.S.-based and holds industry credentials.

Meet Every IRF Requirement

Confirm Admissions and
Documentation Hold Up

Talk with HMI about IRF records review and coding support tailored to your facility.