Provides ongoing education to the staff of the hospital to assure accurate and timely completion of the irfpai. The irf pps will utilize information from a patient assessment instrument irf pai to classify patients into distinct groups based on clinical characteristics and expected resource needs. 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. Medilinks doesnt just offer a list of features, it automates the entire rehab. Inpatient rehabilitation within 30 calendar days after discharge. The day the inpatient rehabilitation facility patient assessment fim statement is filled out. Vendors can also register to receive cms software and system updates. The inpatient rehabilitation facility patient assessment instrument irf pai is collected on all medicare patients who receive services from an inpatient rehabilitation unit or hospital. Irfpai software optimizes inpatient rehab reimbursement. Overview of irf qrp and changes to the irfpai version 3. Irfpai 2017 is more than double the length of the previous assessment. The last four characters of the cmg number are numeric and represent the distinct cmg number. If you do not have the windows 10 operating system on your computer, the upgrade to the. Udsmrs clinical staff are the industry experts for the irfpai.
The irfpai leverages patient data to calculate and determine scores for submission to udsmr and erehab. 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 hospital. Irf pps requires completion of the irfpatient assessment instrument pai, a data collection. Inpatient rehabilitation facility patient assessment. For a complete list of voluntary and mandatory irfpai items, refer to the tables in section 9. The federal regulations require that data must be collected and entered into the data collection software i. Requirements for updating the prospective payment rates under the irf pps. Chapter 11 comparative health information management 3. Information about the aqiq irf pai manual resource tool book. The postadmission physician evaluation for irf patients.
Collected on the irfpai for each patient year round select not in flu season april 1 sept 30 assess vaccination status on admission if not vaccinated, offer vaccine collect information at discharge report on irfpai % of patients who were given the. Mediware information systems mediware information systems. The information provided in the pai is as critical as the care provided. The first character of the cmg number is an alphabetic character and indicates the comorbidity tier. Software related to the submission of irfpai data may be downloaded from the software menu of this web page. This video from the august 2019 inpatient rehabilitation facility irf quality reporting program qrp provider training on held august 15. The pai sp is a powerful diagnostic and interpretive system that offers a variety of modules to meet your specific assessment needs.
If your team has struggled to adapt, or youre still waiting for your ehr to provide a solution, take a look at mediware. Considerations and solutions to successfully complete irfpai v1. The pai sp provides a common framework of basic functionality and features to all enabled pai modules. The jirven software allows irfs to create an electronic irfpai for each patient and produces a report with a distinct cmg number. Anyone other than a facility subject to the payment system who wishes to use the irfpai or the training manual should contact such. Inpatient rehabilitation facility prospective apr 25, 2016 payment systems irf ppss casemix groups and a the other adjustments. Your software and clinical content is updated annually to meet cms irfpai changes. Finally, we will touch on the impact of public reporting. Learn why to stay competitive, providers must have and use evidence that conveys the value of their services. Software related to the submission of irfpai data may be downloaded from the.
These are the same files utilized by thirdparty software vendors to generate similar reports for irfs. Medicare allows for a resident or physician extender to complete the history and physical provided that the rehabilitation physician visits the patient and completes the other required elements of the pape within the 24 hours immediately following irf admission. The verification procedure using the irfpai data will only be used if the ab mac a has verified that the irfs medicare part a feeforservice inpatient population and medicare part c medicare advantage inpatient population combined is at least 50 percent of the irfs total inpatient population in order to verify that an irfs medicare part a feeforservice and medicare part c. Tricare reimburses inpatient rehabilitation facilities irfs on a per. A core set of screening, clinical, and functional status elements that forms the foundation of the comprehensive assessment instrument used for all medicare covered inpatient rehabilitation patients, classifying, and placing them into a. Updated sections of the irf pai manual effective date 10012016 are in a zip file. Udsmr is a notforprofit organization providing the most comprehensive rehabilitation. Overview of the inpatient rehabilitation facility prospective payment system irf pps b. Mar 22, 2020 the draft version data submission specifications include the new standardized patient assessment data elements spades and transfer of health items to align with irf pai version 4. Fy 2020 inpatient rehabilitation facility pps final rule. The irf pai leverages patient data to calculate and determine scores for submission to udsmr and erehab. Patient engagement, clinical management, and the utilization of outcomes marketing are essential strategies for outpatient rehabilitation providers to stay competitive within their community. The irfpai assessment is required for medicare rehabilitation inpatients. This comprehensive tool facilitates the creation, submission and analysis of the inpatient rehabilitation facility patient assessment instrument irfpai required by the centers for medicare and medicaid services.
Inpatient rehabilitation facility patient assessment instrument irf pai page. Irfpai inpatient rehabilitation facility patient assessment irfpai. Anyone other than a facility subject to the payment system who wishes to use the irf pai or the training manual should contact such owners prior to any such use. This comprehensive tool facilitates the creation, submission and analysis of the inpatient rehabilitation facility patient assessment instrument irf pai required by the centers for medicare and medicaid services. Nov 15, 2017 these are the same files utilized by thirdparty software vendors to generate similar reports for irfs. Quality reporting program qrp beginning with the fy 2019 irf qrp. The jirven software allows irfs to create an electronic irfpai for each. Revisions and updates to the irf quality reporting program. Feb 11, 2020 inpatient rehabilitation facility irfpai vendors the purpose of this page is to display technical information related to irfpai software jirven. Uniform data system for medical rehabilitation the functional assessment specialists 11 vcodes on the irfpai use a vcode for aftercare to help tell the story and help support medical necessity example. Understand the importance of specific physician documentation for optimal irfpai.
Meeting the challenge of the irf quality reporting program. Once an irfpai is complete, our late transmission warnings. This video from the irf qrp provider training held may 18 and 19, 2016, presents a high level overview of the changes to the irfpai v1. Identify tiered and compliant conditions by utilizing appropriate resources. Therefore, in regards to who must have responsibility for the irf pps, generally, the person called the irf pai coordinator must meet these requirements. Webbased, skilled nursing and inpatient rehabilitation software to work alongside. Failure to follow timeframes results in penalties a generally, 25 percent reduction in payment. The associated wage index file is available on the irf rules and related files web page. Irf pps requires completion of the irf patient assessment instrument pai, a data collection form completed.
Apr 21, 2020 the irf pps will utilize information from a patient assessment instrument irf pai to classify patients into distinct groups based on clinical characteristics and expected resource needs. The irf pai manual offers itembyitem coding instructions and coding examples for each item for irf staff to accurately complete the irf pai. The validation utility tool vut is a software utility that can be used to validate irfpai submission files in xml format. Irfpai inpatient rehabilitation facilitypatient assessment instrument. As described in the fy 2002 irf pps final rule, upon the admission and discharge of a medicare part a feeforservice patient, the irf is required to complete the appropriate sections of a patient assessment instrument pai, the inpatient rehabilitation facility. Services cms adopted udsmrs fim instrument for the irf pps. You are required to complete all sections of the irf pai on admission by day four, unless its labeled as a discharge area. The software program runs an algorithm that compares the coding on the irfpai data submitted to a list of compliant icd10 codes and impairment group codes igcs to determine the number of cases that fall under certain qualifying criteria.
The accuracy and thoroughness of the specific data recorded on the irfpai, including cms quality measures b. This functionality includes navigation tools, file handling, report editing, and remote telephone and. The paisp provides a common framework of basic functionality and features to all enabled pai modules. In the 2019 irf pps final rule, cms adopted for fy 2020 and later years an unweighted additive. Below is a list of important items associated with the irfpai. The paisp is a powerful diagnostic and interpretive system that offers a variety of modules to meet your specific assessment needs. The most recent version of the irf pai manual is available in the downloads section below. Nov 15, 2011 the information provided in the pai is as critical as the care provided.
Irfpai inpatient rehabilitation facility patient assessment. Inpatient rehabilitation facility prospective payment system for federal fiscal year 2021 is on public display at the office of federal register and will publish on april 21, 2020. The irfpai and the training manual contain proprietary material that was incorporated with the express permission of the owners. Apply to head payments manager, administrative services, coding specialist and more. Who must coordinate the collection of the irf patient.
Inpatient rehabilitation facility irfpai vendors the purpose of this page is to display technical information related to irfpai software jirven. The data collected for irf pai are used to measure quality of care. We will also discuss the strategies to ensure documentation supports the irfpai submission. As described in the fy 2002 irf pps final rule, upon the admission and discharge of a medicare part a feeforservice patient, the irf is required to complete the appropriate sections of a patient assessment instrument pai, the inpatient rehabilitation facilitypatient assessment instrument irfpai. Maintenancefree software from preadmission screening to followup, erehabdata walks you through a complete irfpai solution packed with interactive tools and rich reporting features that guide and support data entry and decisionmaking at every step. Irf draft technical specifications now available qies. Irf pai completion in three days or less does that include. The verification procedure using the irfpai data will only be used if the ab mac a has verified that the irfs medicare part a feeforservice inpatient population and medicare part c medicare advantage inpatient population combined is at least 50 percent of the irfs total inpatient population. M0300d3 stage 4 pressure ulcers discharge unstageable on admission. Inpatient rehabilitation facility irf an irf is a hospital, or part of a hospital, that provides an intensive rehabilitation program to inpatients. The inpatient rehabilitation facility patient assessment instrument irfpai is collected on all medicare patients who receive services from an inpatient rehabilitation unit or hospital. Ub04 stroke is the most common late effectsequela code seen in irfs this table provides a good example of the coding differences on both forms. Patients who are admitted must be able to tolerate an intensive level of rehabilitation services and benefit from a team approach. The draft version data submission specifications include the new standardized patient assessment data elements spades and transfer of health items to align with irfpai version 4.
Separate payments are calculated for each group, including the application of case and facility level adjustments. The data collected for irfpai are used to measure quality of care. Describe how comorbidities impact the cmg for inpatient rehabilitation admissions. The first character of the cmg number is alphabetic character and indicates the comorbidity tier. The udspro system is a comprehensive tool that combines patient. The irf pai and the training manual contain proprietary material that was incorporated with the express permission of the owners. Prospective payment system coordinator i irf in chc pr.
Requirements and conditions for payment under the irf pps. Data must be encoded using inpatient rehabilitation validation and entry irven software 4. Protect your productivity in the face of major irfpai changes. For surgery, also complete and submit the va purchased surgical care patient outcome form if additional care is required, please submit a request for additional care to triwest or the vamc as appropriate. 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 years listed reflect the most recent full year available from the ccw. Understand the importance of specific physician documentation for optimal irfpai coding. Ensure the irfpai finalized at the cms national assessment collection database prior to submitting your claim.
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