Inpatient Facility Coding & Compliance Alert

Question: What is the percent rule and how does it apply to the IRFs?

Minnesota Subscriber

Answer: A hospital can be called an IRF (Inpatient Rehabilitation Facility) depending on the criterion of the percent rule which specifies that a minimum percentage of a hospitals’ total population must require intensive rehabilitation for one of the 13 listed conditions including stroke, spinal cord injury, and amputation amongst others. Payments for I RFs are higher than other hospitals. Originally, the rule required 75 percent of the patients to belong to intensive rehabilitation category. Later, this compliance threshold was assigned a new lower value of 60 percent.

To count in this percentage rule, some of the conditions require that the patient must have had an acute hospitalization for the condition, and documented evidence showing that a less aggressive treatment, such as, twice per week, was performed for a period of three weeks, which failed within 20 days following admission.

If the hospital does not meet this requirement within a year, it will lose its certification as an IRF and will be paid like a usual acute care facility.