Inpatient Rehab Facility (IRF) Excluded Unit Reviews
Inpatient Rehab Facility (IRF) Excluded Unit Review Overview
Those facilities that are currently classified as an Inpatient Rehab Facility (IRF) or that wish to be classified as an IRF must go through an annual review process to determine whether they can continue to be classified as IRF in their upcoming cost reporting period.
This review, commonly referred to as the 75% compliance review, the 75/25 review, or simply the IRF Compliance Review, is based on Section 1886(d)(1)(B)(ii) of the Social Security Act, which provides authority for defining which inpatient facilities may be classified as inpatient rehabilitation hospitals and as acute care hospital rehabilitation units.
Based on the authority provided under the Social Security Act, the regulations at 42 CFR 412.25, 412.29, and 412.30 refer to 42 CFR 412.23(b)(2) (the 75% compliance review) as one of the criteria a provider must meet to be classified as an IRF. Hospitals and units that met the criterion specified in 42 CFR 412.23(b) (2), as well as other criteria, were eligible to be excluded from the Inpatient Prospective Payment System (IPPS.) Historically, this meant that these excluded units would be paid under TEFRA; however, after the implementation of the Inpatient Rehab Facility Prospective Payment System (IRF PPS) on 10/1/05, these excluded units were now paid under their own PPS system. They are still referred to as excluded units because they are excluded from the main IPPS.
Regardless of the timeframe, both IRF Hospitals and IRF units of Acute Care Hospitals must undergo an annual review for continued classification as IRF. Failure to meet the requirements of this review or submit information for this review will result in the termination of the provider's IRF status and subsequent reclassification as an Acute Care Hospital. The process for this review is detailed in CMS Pub. 100-04, Chapter 3, Section 140 and subsections.
The classification review consists of reviewing all or a sample of your total patient population (this includes your Medicare AND Non-Medicare patients) to determine if a specified percentage of them fall under the allowed list of Medical Conditions. Please refer to the following Frequently Asked Questions regarding this annual IRF Classification Review.
Inpatient Rehabilitation Facility (IRF) Classification Frequently Asked Questions
Listing of Allowable IRF Medical Conditions
Sample of IRF Listing to Submit 
Sample Written Certification (For New Providers or an Expansion with "New" Beds)
Page Last Updated: Thursday, 18-Mar-2010 05:48:32 CDT
