Licensure Board

Part A Diagnosis Determinations

Recent internal and external IRO and Medicare audit focus has been centered around review of medical and treatment diagnoses on our therapy documentation, and whether those diagnoses support the need for treatment under a Part A stay. In order for therapy to qualify for Part A reimbursement, it must be related to a qualifying hospital stay. This means that our documentation and diagnoses need to support that the issues we are treating are either directly or indirectly related to the reason your patient was in the hospital.

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