Oasis Point Rehabilitation Hospital - Zero-Fault Accuracy
⚠️ CRITICAL TIMELINES - DO NOT MISS
- PAS: Must be signed by physician BEFORE admission
- IPOC: Must be completed within 4 days of admission
- Physician Face-to-Face: At least 3x per week
- IDT Meetings: Weekly with physician participation documented
- Therapy Minutes: 15 hours in first 7 days (3 hrs/day, 5 days/week)
- IRF-PAI Submission: Within 30 days of discharge
📊 60% RULE - CMS-13 CATEGORIES
01: Stroke
02: Traumatic Brain Injury
03: Non-traumatic Brain Injury
04: Traumatic Spinal Cord Injury
05: Non-traumatic Spinal Cord Injury
06: Neurological Disorders
07: Fracture of Lower Extremity
08: Joint Replacement Lower Extremity
09: Other Orthopedic
10: Amputation Lower Extremity
11: Amputation Other
12: Osteoarthritis
13: Rheumatoid Arthritis
14: Cardiac
15: Pulmonary
16: Pain Syndrome
17: Major Multiple Trauma (no brain/spinal)
18: Major Multiple Trauma (brain/spinal)
19: Guillain-Barré
20: Miscellaneous
21: Burns
🚨 TOP MAC AUDIT TRIGGERS
- ✗ PAS signed after admission date
- ✗ IPOC completed after 4-day deadline
- ✗ Missing physician face-to-face visits
- ✗ Therapy minutes don't meet 15 hours in week 1
- ✗ IRF-PAI data doesn't match medical record
- ✗ Missing IDT meeting documentation
- ✗ Inappropriate admission (doesn't meet medical necessity)
- ✗ Failed 60% Rule presumptive compliance
- ✗ Comorbidities not properly documented for tier
✓ IRF-PAI CODING CHECKLIST
- ☐ Primary diagnosis matches physician documentation
- ☐ ICD-10 code is specific (not unspecified)
- ☐ IGC code matches CMS-13 list
- ☐ Admission/discharge dates are accurate
- ☐ All comorbidities counted for RIC tier
- ☐ Functional status scores match therapy notes
- ☐ Discharge destination is correct
- ☐ All required fields completed (no blanks)
- ☐ Cross-check with medical record before submission
📋 MEDICAL NECESSITY CRITERIA
ALL 5 must be met:
- 1. Appropriate Diagnosis: Requires intensive rehabilitation
- 2. Multiple Disciplines: Needs 2+ therapy types (PT, OT, ST)
- 3. Intensive Program: Can tolerate 3 hours/day, 5 days/week
- 4. Physician Oversight: Rehab physician manages care
- 5. Measurable Improvement: Reasonable expectation of functional gain
🎯 RIC TIER ASSIGNMENT
Tier 1: No comorbidities
Tier 2: 1-2 comorbidities
Tier 3: 3+ comorbidities
Common Comorbidities:
- • Diabetes
- • Hypertension
- • COPD/Respiratory
- • CHF/Cardiac
- • Renal disease
- • Obesity (BMI ≥40)
📅 DAILY WORKFLOW REMINDERS
MORNING (8:00 AM)
- • Review new admissions
- • Check PAS completion
- • Verify physician orders
MIDDAY (12:00 PM)
- • Monitor therapy minutes
- • Check IPOC deadlines
- • Review pending discharges
AFTERNOON (4:00 PM)
- • Complete IRF-PAI assessments
- • Quality check documentation
- • Submit completed IRF-PAIs
📞 EMERGENCY CONTACTS
- Training Director: [Phone]
- Compliance Officer: [Phone]
- Rehab Physician: [Phone]
- MAC Hotline: [Phone]
❓ WHEN IN DOUBT
- STOP - Don't guess
- CHECK - Review IRF-PAI Manual Chapter 2
- ASK - Contact supervisor or training director
- DOCUMENT - Note questions for training
- NEVER submit an IRF-PAI you're unsure about!
Oasis Point Rehabilitation Hospital - IRF-PAI Accuracy Training Program
For questions or clarification, contact the Training Director
Last Updated: 1/25/2026 | Version 1.0
💡 Tip: Print this guide and keep it at your desk for quick reference during IRF-PAI coding