HEALTHCARE PROFESSIONALS

Admission Criteria & Qualifying Diagnosis

CMS has defined five Medical Necessity Criteria that must be met in order to justify the admission to the Inpatient Rehab program. In order to qualify for admission to this program, the patient MUST meet ALL of the following:

  • Require two therapy disciplines, one of which must be PT or OT
  • Be able to participate in an intensive program, generally defined as 3 hours of therapy 5 out of 7 days
  • Be able to actively participate and benefit significantly from an intensive rehabilitation therapy program
  • Medical and functional needs require close supervision by a rehabilitation physician at least 3 days a week
  • Require a coordinated, interdisciplinary rehabilitation team approach

 

PATIENT DIAGNOSIS THAT MAY QUALIFY FOR INPATIENT REHABILITATION:

Any patient who meets the medical necessity criteria can qualify for admission to the inpatient rehabilitation program.

CMS has identified 13 diagnostic categories that must make up 60% of the total admissions for our program:

  • Stroke
  • Spinal Chord Injury
  • Brain Injury
  • Amputation
  • Active Polyarticular Rheumatoid Arthritis
  • Burns
  • Congenital Deformities
  • Hip Fracture
  • Major Multiple trauma (with multiple long bone fractures)
  • Neurological Disorders (MS, Parkinson’s, Myelopathy, Polyneuropathy)
  • Systemic Vasculidities
  • Elective Hip and Knee replacements (These are highly scrutinized and must have active medical conditions continuing to require close physician management and cannot be safely managed at a lower level of care.)

40% OF THE REHABILITATION PROGRAM’S ADMISSIONS CAN HAVE ANY DIAGNOSIS SUCH AS:

  • Cardiology- Post MI, valve diseases, resolving left, right or bilateral failure events (CHF)
  • Pulmonology- COPD, Complicated and/or elderly Pneumonia and Flu, respiratory failure
  • Endocrinology- Diabetic Neuropathy
  • General Acute Conditions- Pneumonia, UTI, dehydration, Septicemia
  • Post-Surgical Issues- Infection, Cardiac and Pulmonary condition


Insurance Information

Our admission liaisons will assist in determining whether an insurance plan will cover an inpatient rehabilitation stay. Prior authorization is frequently required before a patient can be admitted to Inpatient Rehab. This process usually takes 24-48 hours to complete before admission is approved.

WellStar North Fulton Hospital accepts most major medical insurances including Medicare and Medicaid. For more information, call an admission liaison in our inpatient rehabilitation unit at 770-751-2630.


Certifications

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