IRF PAI MASTERY

Understanding the IRF PAI Challenge, Success & Mastery How to TIPS after 7,000 Encoded Cases Jan Brown, RN Mary Walters, RN IRF PAI Coordinators – Best Practice Tips / Advice Collaboratively Prepared: Darlene L. D’Altorio-Jones, PT. MBA HCM – (21 years of IRF Experience)

Understanding the IRF PAI Inpatient Rehabilitation Facility Patient Assessment Instrument ,[object Object]

Objectives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

IRF PAI – Beginning & Purpose ,[object Object],[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

Know Importance of IRF Alphabet Soup ,[object Object],[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

Know Importance of IRF Alphabet Soup ,[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

Know Importance of IRF Alphabet Soup ,[object Object],[object Object],[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

60/40 vs. Medically Necessary ,[object Object],[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

60/40 vs. Medically Necessary ,[object Object],[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation A LCD consists only of information pertaining to when a procedure is considered medically reasonable and necessary (e.g. indications and ICD-9-CM codes), whereas a LMRP also included information such as coding guidelines.

60/40 vs. Medically Necessary ,[object Object],[object Object],[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

60/40 vs. Medically Necessary ,[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

60/40 vs. Medically Necessary ,[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

Medically Necessary HCFA 85-2 Ruling ,[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

Medically Necessary HCFA 85-2 Ruling ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

What’s so Confusing? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

What’s so Confusing? ,[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

What’s so Confusing? ,[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

Why IRF & UB – 04’s Don’t Align ,[object Object],[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

Why IRF & UB – 04’s Don’t Align ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

Experienced Tool User Tips ,[object Object],[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

Experienced Tool User Tips ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

Experienced Tool User Tips ,[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

Experienced Tool User Tips ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

Experienced Tool User Tips ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

Experienced Tool User Tips ,[object Object],[object Object],[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

Experienced Tool User Tips ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation PAYOR D/C ENCODE / Transmitted DATE 5 DAYS POST D/C PAI D/C REF DATE IGC CMG Target D/C PAI D/C by ENCODE DAY #10 ADMIT PAI 72 hour date ARD DATE ADMIT DATE 75% RULE Y or N NAME

Experienced Tool User Tips ,[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

Experienced User Tips- Continued ,[object Object],[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation 0 0 0 Did not occur 1 1 1 LPN/ppn/IV fluids for hydration 1 1 1 Staff performs feeding (including tube feeds) 5 5 5 Needs only set-up/cues/supervision to perform tube feeding 6 6 6 Performs own tube feeding 2 2 2 Unable to put food on utensil and bring food to mouth 3 3 3 Unable to put food on utensil 4 4 4 Needs help steadying or checking mouth for pocketing 5 5 5 Feeds self with set-up/cues /supervision 6 6 6 Feeds self with adaptive equipment / dentures/ modified diet 7 7 7 Pt feeds self N E D Eating (3 parts: scooping to mouth, chew & swallow)

Experienced User Tips- Continued ,[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

Experienced Tool User Tips – Daily Checklist Encoding Advocacy through Appropriate PAI Documentation Preadmission data gathering – thorough & accurate per guidelines. Establish Medical Necessity through 85-2 Criteria – then admit! Reconcile Daily Census; target deadlines for submission (initial vs. final) encoding. Know Regulations for interruptions, comorbid conditions, complications & Allowable CMG’s for 60% compliance.

Experienced Tool User Tips – Daily Checklist Encoding Advocacy through Appropriate PAI Documentation Communicate LOS, Barriers to Discharge Review consistency in FIM documentation across disciplines. Be certain elements encoded are supported by ALL documentation starting with the physician and H & P to all other clinical caregivers. Be timely in final submission. Communicate with Finance & HIM coders for accurate capture to the UB and other billing documents.

Questions – How to Get them Answered ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

Questions – How to Get them Answered ,[object Object],[object Object],[object Object],[object Object],Encoding Advocacy through Appropriate PAI Documentation

Pre Test / Post Test ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pre Test / Post Test ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pre Test / Post Test ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

IRF PAI MASTERY

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