IRF-PAI Accuracy Training Platform

Audit Information

Complete for each patient record reviewed

Audit Date

Auditor Name

Patient MRN

Overall Compliance Score0%

0 of 28 items passed

✗ Compliance concerns identified. Immediate corrective action required.

Category Breakdown

Documentation Review

0%0/6

IRF-PAI Accuracy

0%0/7

60% Rule Compliance

0%0/3

Medical Necessity

0%0/4

FIM Scoring

0%0/4

Comorbidity Coding

0%0/4

Documentation Review0/6

Medical record contains physician admission orders

H&P completed within 24 hours of admission

Preadmission screening documented

Rehabilitation physician face-to-face visit within 24 hours

Individualized plan of care (IPOC) completed by Day 4

Weekly team conference notes present

IRF-PAI Accuracy0/7

Admission FIM scores match therapy notes from Days 1-3

Discharge FIM scores match therapy notes from last 2 days

All comorbidities have documented active treatment evidence

Tier assignment matches comorbidity count

ICD-10 codes match physician documentation

Admission and discharge dates are accurate

IRF-PAI submitted within required timeframe

60% Rule Compliance0/3

Primary diagnosis is one of the 13 CMS qualifying conditions

IGC code correctly assigned based on diagnosis

Facility tracking shows ≥60% compliance for current period

Medical Necessity0/4

Patient requires intensive rehabilitation (3 hours/day, 5 days/week)

Patient can tolerate and benefit from intensive therapy

Therapy notes document patient participation and progress

Discharge plan supports IRF-level care was appropriate

FIM Scoring0/4

FIM scores are consistent across all disciplines

FIM gain is realistic for diagnosis and LOS

Cognitive FIM items appropriately scored (not all 7s)

Bladder/bowel management scored correctly

Comorbidity Coding0/4

Only actively treated comorbidities are coded

High-impact comorbidities have supporting documentation

No 'history of' diagnoses coded as active

Comorbidity tier matches documented complexity

Internal Audit Best Practices

Monthly Frequency: Conduct internal audits on at least 5-10 randomly selected patient records per month to identify trends and training needs.

Random Selection: Use a random number generator or select every Nth patient to avoid selection bias. Include a mix of diagnoses and payers.

Score Threshold: Records scoring below 85% require immediate corrective action. Records scoring 85-94% should be reviewed for improvement opportunities.

Trend Analysis: Track common errors across multiple audits. If the same category consistently scores low, implement targeted training.

Documentation: Export and save audit results for quality committee review and MAC audit defense preparation.

Follow-Up: For records with errors, implement corrective action within 48 hours and re-audit the same patient type within 30 days.