Solving the riddle of inpatient rehabilitation coverage.
Ruling 85-2 sets forth eight criteria that, if satisfied, conclusively establish that an inpatient hospital rehabilitation stay is medically necessary: Close medical supervision by a physician with specialized training or experience in rehabilitation. Twenty-four hour rehabilitation nursing. Relatively intense level of rehabilitation services. Multidisciplinary team approach to delivery of program. Coordinated program of care. Significant practical improvement. Realistic goals. Length of rehabilitation program.
Connelly
Ronald S
RS
Powers, Pyles, Sutter & Verville, P.C., Washington, DC, USA. Ron.Connelly@ppsv.com
Thomas
Peter W
PW
D014487:Centers for Medicare and Medicaid Services, U.S.; D004608:Eligibility Determination / Q000331:legislation & jurisprudence*; D006801:Humans; D007297:Inpatients; D019458:Insurance Coverage / Q000331:legislation & jurisprudence*; D012046:Rehabilitation / Q000191:economics; D014481:United States