Inpatient Rehabilitation Facility Review Choice Demonstration and Short Stay Transfers

Published 06/06/2025

Inpatient Rehabilitation Facility (IRF) short stays and short stay transfers of three days or less are not included in the IRF RCD and do not require a Unique Tracking Number (UTN).

When a beneficiary is admitted to an IRF but is transferred out as described in 42 Code of Federal Regulations (CFR) 412.624(f) within three days or less of the admission, the provider may not be able to complete all documentation due to the timing of the transfer to meet the coverage requirements listed in the CFR.

Therefore, when a short stay claim is billed for three days or less, Palmetto GBA will identify the claim based on the dates of service billed. The claims billed for three days may or may not be short stay transfers.

The claims processing system is unable to accurately identify and exclude those claims that were three days that didn’t include a UTN. For these claims, Palmetto GBA will send an additional documentation request (ADR) and the IRF provider shall submit documentation to the Medicare Administrative Contractor (MAC) to support an appropriate IRF admission, short stay, or short stay transfer.

The below scenarios identify the action a provider should take in the event of an ADR for short stays or short stay transfers that occurred on the third day or greater:

  • If the admission is for a short stay or short stay transfer (transfers of three days or less), the provider shall submit documentation (such as progress notes, nursing notes, discharge summaries, etc.) that confirms the specific timing of the transfer/discharge. 
    • If the documentation confirms a short stay or short stay transfer, the MAC will process the claim as normal and the IRF’s affirmation rate will not be impacted
    • If the documentation does not confirm a short stay or short stay transfer, the MAC will contact the provider to request the full medical record. The MAC will conduct a full review, process the claim as normal, and the IRF’s affirmation will be impacted.
       
  • If the admission is not for a short stay or short stay transfer (transfer of three days or less), the provider shall submit the full medical record to support that the claim met IRF requirements
    • The MAC will conduct a full ADR review, process the claim as normal, and the IRF’s affirmation rate will be impacted

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