The New IRF-PAI:
Updates to eRehabData for
FY2015
September 9, 2014
Melissa Berkoff
Kristen Smith
Objectives
• Review upcoming IRF-PAI changes effective October 1,
2014
• Provide clinical considerations of the new wound and
influenza vaccination requirements
• Demonstrate eRehabData screens and functionality
pertaining to the new IRF-PAI and CMS QRP
requirements
IRF-PAI: Identification Information
15A. Admit From (New)
15. Admit From (Previous)
01- Home
02- Board & Care
03- Transitional Living
04- Intermediate Care
05- Skilled Nursing Facility
06- Acute Unit of Own Facility
07- Acute Unit of Another Facility
08- Chronic Hospital
09- Rehabilitation Facility
10- Other
12- Alternative Level of Care
13- Subacute Setting
14- Assisted Living Residence
01- Home
02- Short-term General Hospital
03- Skilled Nursing Facility
04- Intermediate Care
06- Home under care of organized
home health service organization
50- Hospice (home)
51- Hospice (institutional facility)
61- Swing bed
62- Another Inpatient Rehabilitation
Facility
63- Long-Term Care Hospital
(LTCH)
64- Medicaid Nursing Facility
65- Inpatient Psychiatric Facility
66- Critical Access Hospital
99- Not Listed
IRF-PAI: Identification Information
16. Pre-hospital Living Setting
(Previous)
01- Home
02- Board & Care
03- Transitional Living
04- Intermediate Care
05- Skilled Nursing Facility
06- Acute Unit of Own Facility
07- Acute Unit of Another Facility
08- Chronic Hospital
09- Rehabilitation Facility
10- Other
12- Alternative Level of Care
13- Subacute Setting
14- Assisted Living Residence
16A. Pre-hospital Living Setting
(New)
01- Home
02- Short-term General Hospital
03- Skilled Nursing Facility
04- Intermediate Care
06- Home under care of organized
home health service organization
50- Hospice (home)
51- Hospice (institutional facility)
61- Swing bed
62- Another Inpatient Rehabilitation
Facility
63- Long-Term Care Hospital
(LTCH)
64- Medicaid Nursing Facility
65- Inpatient Psychiatric Facility
66- Critical Access Hospital
99- Not Listed
IRF-PAI: Identification Information
Deleted Items:
18. Pre-Hospital Vocational Category
19. Pre-Hospital Vocational Effort
IRF-PAI: Payer Information
20. Payment Source (Previous)
20. Payment Source (New)
01- Blue Cross
02- Medicare, non-MCO
03- Medicaid non-MCO
04- Commercial Insurance
05- MCO HMO
06- Worker’s Compensation
07- Crippled Children’s Services
08- Developmental Disabilities Services
09- State Vocation Rehabilitation
10- Private Pay
11- Employee Courtesy
12- Unreimbursed
13- CHAMPUS
14- Other
15- None
16- No-Fault Auto Insurance
51- Medicare MCO
52- Medicaid MCO
02- Medicare Fee For Service
51- Medicare-Medicare Advantage
99- Not Listed
IRF-PAI: Medical Information
24. Comorbid Conditions
 10 ICD codes to 25 ICD codes
25. Is patient comatose at admission- DELETED
26. Is patient delirious at admission- DELETED
25A. Height on admission (in inches) – ADDED
26A. Weight on admission (in pounds)- ADDED
28. Clinical signs of dehydration- DELETED
IRF-PAI: Discharge Information
44A. Discharge to Living
Setting (Previous)
44D. Discharge to Living Setting
(New)
01- Home
02- Board & Care
03- Transitional Living
04- Intermediate Care
05- Skilled Nursing Facility
06- Acute Unit of Own Facility
07- Acute Unit of Another Facility
08- Chronic Hospital
09- Rehabilitation Facility
10- Other
12- Alternative Level of Care
13- Subacute Setting
14- Assisted Living Residence
01- Home
02- Short-term General Hospital
03- Skilled Nursing Facility
04- Intermediate Care
06- Home under care of organized home health
service organization
50- Hospice (home)
51- Hospice (institutional facility)
61- Swing bed
62- Another Inpatient Rehabilitation Facility
63- Long-Term Care Hospital (LTCH)
64- Medicaid Nursing Facility
65- Inpatient Psychiatric Facility
66- Critical Access Hospital
99- Not Listed
IRF-PAI: Discharge Information
44B. Was patient discharged with Home Health Services?- DELETED
 Replaced with discharge living setting 06 – Home under care of organized
home health service organization
44C. Was the patient discharged alive?- ADDED
Quality Indicators- Admission Assessment
Unhealed Pressure Ulcer(s) - Admission
*M0210. Does this patient have one or more unhealed pressure ulcer(s) stage
I or higher at admission?
 No, skip to question I0900 on admission assessment
 Yes, continue to question M0300A on admission assessment
M0300. A-G: Current number of unhealed pressure ulcer(s) at each
stage-Admission:
M0300A1. Stage I
*M0300B1. Stage II
*M0300C1. Stage III
*M0300D1. Stage IV
M0300E1. Unstageable due to non-removable dressing/device
M0300F1. Unstageable due to slough and/or eschar
M0300G1. Unstageable with suspected deep tissue injury
* Mandatory reporting items
Quality Indicators- Admission Assessment
I0900.- Pressure Ulcer Risk Conditions - Admission
Indicate below if the patient has any of the following pressure ulcer risk
conditions:
*I0900A. Peripheral Vascular Disease (PVD)
*I0900B. Peripheral Artery Disease (PAD)
*I2900A. Diabetes Mellitus (DM)
If I2900A.= No, skip I2900B-D
I2900B. Diabetic Retinopathy
I2900C. Diabetic Nephropathy
I2900D. Diabetic Neuropathy
* Mandatory reporting items
Quality Indicators- Discharge Assessment
Unhealed Pressure Ulcer(s) - Discharge
*M0210. Does this patient have one or more unhealed pressure ulcer(s) stage
I or higher at discharge?
 No, skip to question M0900A on discharge assessment
 Yes, continue to question M0300A on discharge assessment
M0300. A-G: Current number of unhealed pressure ulcer(s) at each
stage- Discharge:
M0300A1. Stage I
Mo300A2. Stage I present on admission and remained Stage I
M0300A3. Stage I NOT present on admission
*M0300B1. Stage II
M0300B2. Stage II present on admission and remained Stage II
Mo300B3. Stage II present on admission as unstageable, staged as a Stage
II, remained Stage II at discharge
*M0300B4. Stage II NOT present on admission or were at a lesser stage at
admission and worsened to a Stage II
* Mandatory reporting items
Quality Indicators- Discharge Assessment
M0300. A-G (Cont.): Current number of unhealed pressure ulcer(s)
at each stage- Discharge:
*M0300C1. Stage III
Mo300C2. Stage III present on admission and remained Stage III
M0300C3. Stage III present on admission as unstageable, staged as a
Stage III, remained Stage III at discharge
*M0300C4. Stage III NOT present on admission or were at a lesser stage
at admission and worsened to a Stage III or were unstageable at admission
and initially staged at a lesser stage and progressed to a Stage III by the
time of discharge
* Mandatory reporting items
Quality Indicators- Discharge Assessment
M0300. A-G (Cont.): Current number of unhealed pressure ulcer(s)
at each stage- Discharge:
*M0300D1. Stage IV
M0300D2. Stage IV present on admission and remained stage IV
Mo300D3. Stage IV present on admission as unstageable, staged as a Stage
IV, remained Stage IV at discharge
*M0300D4. Stage IV NOT present on admission or were at a lesser stage
at admission and worsened to a Stage IV or were unstageable at admission
and initially staged at a lesser stage and progressed to a Stage IV by the
time of discharge
* Mandatory reporting items
Quality Indicators- Discharge Assessment
M0300. A-G (Cont.): Current number of unhealed pressure ulcer(s)
at each stage- Discharge:
M0300E1. Unstageable due to non-removable dressing or device
Mo300E2. Present on admission as unstageable due to non-removable
dressing or device and remained unstageable due to non-removable
dressing or device
M0300E3. Present on admission as a stageable pressure ulcer and then
became unstageable due to a non-removable dressing or device and
remained unstageable due to non-removable dressing or device at time of
discharge
Quality Indicators- Discharge Assessment
M0300. A-G (Cont.): Current number of unhealed pressure ulcer(s)
at each stage- Discharge:
M0300F1. Unstageable due to slough and/or eschar
M0300F2. Present on admission as unstageable due to slough and/or
eschar and remained unstageable due to slough and/or eschar
M0300F3. Present on admission as a stageable pressure ulcer and then
became unstageable due to slough and/or eschar and remained
unstageable due to slough and/or eschar at time of discharge
Quality Indicators- Discharge Assessment
M0300. A-G (Cont.): Current number of unhealed pressure ulcer(s)
at each stage- Discharge:
M0300G1. Unstageable with suspected deep tissue injury
Mo300G2. Present on admission as unstageable with suspected deep
tissue injury and remained unstageable with suspected deep tissue injury
M0900. Healed pressure ulcer(s)- Discharge
Indicate the number of pressure ulcers present on admission and have
completely closed (resurfaced with epithelium) upon discharge
M0900A. Stage I
M0900B. Stage II
M0900C. Stage III
M0900D. Stage IV
Quality Indicators- Influenza Vaccination
O0250. Influenza Vaccine- Discharge
*O0250A. Did the patient receive the influenza vaccine in this facility for
this year's influenza vaccination season?
 No- skip to O0250C
 Yes-continue to O0250B
*B. Date influenza vaccine received
• MM/DD/YYYY
*C. If influenza vaccine not received, state reason:
•
•
•
•
•
•
•
Patient not in facility during flu season
Received outside of this facility
Not eligible - medical contraindication
Offered and declined
Not offered
Inability to obtain influenza vaccine due to a declared shortage
None of the above
* Mandatory reporting items
IRF-PAI: Signature Page
Z0400A. Signature of Persons Completing the Assessment




Signature
Title
Date Information is Provided
Time
eRehabdata demo of IRF-PAI Revisions
Considerations:
Identification/Payer Information
• Data Entry
 Education on definitions of revised data elements
• Reporting
 Pre-post FY 15 data collection and reporting
• Admissions analysis
• Discharge disposition analysis
Pressure Ulcers: Clinical Considerations
• Identification
 Rule out other types of wounds
• Staging
 Unstageable on admission
 Healed at discharge
• Timing
 Assessment reference periods
• Voluntary Reporting
Pressure Ulcers: Identification
CMS Pressure Ulcer Definition
A pressure ulcer is a localized injury to the
skin and/or underlying tissue usually over
a bony prominence, as a result of pressure,
or pressure in combination with shear
and/or friction.
Adapted from the NPUAP 2007 definition of a pressure ulcer
Pressure Ulcers: Clinical Processes
• Identification (present on admission)




Skin assessments
Timing
Roles/Responsibilities
Supporting documentation
• Prevention
 Risk assessment (Braden; predictive modeling)
 Interventions
•
•
•
•
•
Surfaces
Nutrition
Turning teams
Mobility
Patient/Family education
• Intervention
 Wound Healing
Clinical Applications: Influenza Vaccination
• Data Collection
 Process
• Clinical liaisons during pre-admission assessment
• Nurse report upon admission
 Documentation
• Location of information
• Structure of the questions
Mirror the IRF-PAI questions
• Clinical Standards of Care:
 Acute care admissions
 Clinical decision making
• Availability of information
• Standards of clinical practice
 Competencies
Reporting: Pressure Ulcers
• Documentation- Risk Factors
 Consistent with co-morbidity section
• Documentation- Skin
 Source and location of information
 Structure of the questions
• Mirror the IRF-PAI questions
• Validation
 IRF-PAI and medical record
Reporting: Influenza Vaccination
• Data entry/reporting
 Timelines
• Flu vaccination season
 Accuracy
 Validation
• Supporting documentation
Considerations: Signature Page
• Includes all individuals completing the IRF-PAI




Identification/Payer
Medical
Quality
FIM
• Maintained in the medical record along with the IRFPAI
 IRF coverage requirements
 CMS conditions of participation
Looking Ahead: IRF-PAI FY 16
• FY 15 Final Rule IRF-PAI Changes for Next Year
 Arthritis conditions meeting requirements for IRF classification
criteria (60% rule)
 Therapy information section
• Minutes and mode (individual, concurrent, group, co-treatment)
• Two week duration of data collection
Questions?
[email protected]
Next call: IRF-PPS Updates for FY2015
October 7, 1:00 PM

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