Medicare Guidelines for Inpatient Rehab

Medicare guidelines for admission are strict and rules on compliance with these guidelines are sometimes confusing.

On any given day the criteria for admission may shift slightly depending on the compliance status of the rehabilitation unit at that time.

The approved diagnoses are:

• Amputations
• Hip fractures
• Cerebrovascular accident
• Spinal cord dysfunction
  – Dorsal or lumbar spinal cord injury with paraparesis/paraplegia
  – Cervical spinal cord injury with quadriparesis/quadriplegia
• Brain injury dysfunction
• Major multiple trauma
• Neurological disorders (including Multiple Sclerosis, Parkinson's Disease, Polyneuropathy, Guillain-Barré)
• Burns
• Congenital deformity
• Very limited Polyarticular Rheumatoid Arthritis, Systemic Vasculidities and Osteoarthritis
• Knee or hip joint replacement allowed if:
  • bilateral replacements were performed
  • patient is 85 or older
  • BMI is 50 or above

Co-morbidity

Patients needing Acute Inpatient Rehabilitation may qualify with certain co-morbidities. Some co-morbid conditions that are exacerbated by a spell of illness qualify a patient for that chance at independence.

Some common co-morbid conditions include:

• An old, untreated CVA
• COPD
• Parkinson’s
• Multiple Sclerosis
• Heart disease
• ALS

Our Program Director or Case Coordinator will contact you immediately about the viability of admission for your referral. They can tell you if your patient has the potential for admission based on their diagnosis and the status of their compliance that month. Together we can help your patient recover and achieve as much independence as possible.

If you believe a patient may benefit from our services, please phone us. A member of our staff will perform a screening at no charge. If it is determined that the patient is not a candidate for inpatient rehabilitation, alternate resources will be discussed.