Member May 2025: Fighting the Good Fight: Insights on Inpatient Rehabilitation Admission Changes (On Demand)-Session Recording

Video Transcription

Video Summary

The AAPMNR's Member May Series session focused on insights regarding inpatient rehabilitation and changes in admission processes. Various perspectives were shared by experts, with Dr. Craig DiTomaso moderating the session. Key discussions revolved around strategies to improve inpatient rehabilitation admissions processes, optimizing Medicare Rehabilitation Choice Demonstration Programs, and managing denials and appeals for Medicare Advantage patients. <br /><br />Dr. Shannon Smith-Hamilton emphasized understanding referral bases and addressing barriers to timely admissions, such as delays in therapy evaluations and medical stability issues. She highlighted the importance of effective communication with case management to streamline referrals and advocated for planning around complex patient groups like organ transplant or LVAD patients.<br /><br />Dr. Keith Foster discussed the CMS Rehabilitation Choice demonstration program, emphasizing the importance of accurate and consistent documentation for rehabilitation candidates. He underscored the role of physiatrists in ensuring every case is justified with a clear story of patient needs and goals, especially as more states adopt this program.<br /><br />Dr. Vishwa Raj presented on strategies for addressing denials and appeals for Medicare Advantage patients. He highlighted the significance of understanding legal processes, especially when dealing with administrative law judges. Dr. Raj's team saw success by moving patients to inpatient rehab while authorization was pending and appealing denials through structured processes, resulting in high approval rates.<br /><br />The session concluded with audience questions, focusing on the role of family-initiated appeals and practical tips for dealing with insurance denials, while reiterating the importance of collaboration and thorough documentation in these cases.

Keywords

inpatient rehabilitation

admission processes

Medicare Rehabilitation Choice

denials and appeals

Dr. Craig DiTomaso

referral bases

case management

CMS demonstration program

documentation

insurance denials