Inpatient Rehabilitation Facility RCD Top 3 Non-Affirmation and Claim Denial Reasons

Published 04/13/2026

We encourage all providers to review this information to ensure timely processing of claims and pre-claim review (PCR) requests. The following chart shows the cumulative non-affirmation and claim denial reasons for Alabama Inpatient Rehabilitation Facility (IRF) Review Choice Demonstration (RCD) providers. 

Cycle 1 Top 3 Non-Affirmations

Table 1. Cycle 1.
Rank Code Category Description
1 IRF5A Medical Necessity

The documentation does not support the beneficiary required supervision by a rehabilitation physician.
Refer to:
2 IRF5D Medical Necessity

The documentation does not support the patient is sufficiently stable at the time of admission to the IRF to be able to actively participate in and benefit significantly from the intensive rehabilitation therapy program. Refer to:
3 IRF8G

Medical Necessity — Therapy Services

Documentation does not support that therapy services began within 36 hours from midnight of the day of admission to the IRF. Refer to:  

Cycle 2 Top 3 Non-Affirmations

Table 2. Cycle 2.
Rank Code Category Description
1 IRF5A Medical Necessity

The documentation does not support the beneficiary required supervision by a rehabilitation physician. Refer to:
2 IRF5D Medical Necessity

The documentation does not support the patient is sufficiently stable at the time of admission to the IRF to be able to actively participate in and benefit significantly from the intensive rehabilitation therapy program. Refer to:
3 IRF5B Medical Necessity

Documentation does not support that upon admission to the IRF the patient generally required the intensive rehabilitation therapy services that are uniquely provided in IRFs. Refer to:

Cycle 3 Top 3 Non-Affirmations

Table 3: Cycle 3.
Rank Code Category Description
1 IRF5A Medical Necessity

The documentation does not support the beneficiary required supervision by a rehabilitation physician. Refer to:
2 IRF5D Medical Necessity

The documentation does not support the patient is sufficiently stable at the time of admission to the IRF to be able to actively participate in and benefit significantly from the intensive rehabilitation therapy program. Refer to:
3 IRF5B Medical Necessity

Documentation does not support that upon admission to the IRF the patient generally required the intensive rehabilitation therapy services that are uniquely provided in IRFs. Refer to:

Cycle 4 Top 3 Non-Affirmations

Table 4: Cycle 4.
Rank Code Category Description
1 IRF5H Medical Necessity The documentation does not support that the patient is able to actively participate in and benefit significantly from the intensive rehabilitation therapy program. Refer to:
2 IRF2N Insufficient Documentation
Pre-Admission Screening		 The preadmission screen does not include a detailed and comprehensive review of the patient's condition and medical history. Refer to: 
3 IRF5D Medical Necessity The documentation does not support the patient is sufficiently stable at the time of admission to the IRF. Refer to:

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