NCTRC Healthcare Settings, Reimbursement, and Regulatory Compliance 2

Question 1

Under Medicare's inpatient rehabilitation facility (IRF) intensity rule, a patient generally must be able to tolerate how much therapy?

Accepted Answer

3 hours per day, at least 5 days per week

Answer

The IRF "3-hour rule" requires intensive therapy of at least 3 hours per day, 5 days per week, or 15 hours over 7 days.

Question 2

Which disciplines are counted toward the IRF intensive therapy requirement?

Accepted Answer

PT, OT, SLP, and orthotics/prosthetics

Answer

CMS counts PT, OT, speech-language pathology, and orthotics/prosthetics toward the intensity requirement; RT is part of the interdisciplinary team but is not counted.

Question 3

The IRF "60% rule" requires that at least 60% of an IRF's patients:

Accepted Answer

Have one of the CMS-specified qualifying medical conditions

Answer

At least 60% of an IRF's patients must have one or more of 13 qualifying conditions, such as stroke, spinal cord injury, or brain injury.

Question 4

Which assessment instrument must be completed for Medicare patients admitted to an inpatient rehabilitation facility?

Accepted Answer

IRF-PAI

Answer

The Inpatient Rehabilitation Facility–Patient Assessment Instrument (IRF-PAI) drives IRF PPS payment and quality reporting.

Question 5

In acute care hospitals, Medicare inpatient payment under the IPPS is based on:

Accepted Answer

Diagnosis-Related Groups

Answer

Acute hospitals receive a fixed payment per discharge based on the patient's Diagnosis-Related Group (MS-DRG).

NCTRC Test Practice Test

NCTRC Test Practice Test

NCTRC Healthcare Settings, Reimbursement, and Regulatory Compliance 2