Inpatient rehabilitation can be a very helpful option for recovery from acute illness. Often it is a struggle for hospitals to get this high-level acute rehabilitation stays approved by insurers. Payers will divert many of these referrals to a lower level of care using a tight interpretation of commonly used criteria and/or Medicare coverage policies.
Knowing how to interpret admission criteria for therapy services combined with an understanding of necessary medical complexity is required to get payer approval for as many of these referrals as possible.
Cadenza Health's expert team has a clinical background in all settings of post-acute care. In addition, we have years of experience reviewing inpatient rehabilitation requests for medical necessity. Combined, these areas of expertise allow us to provide general consultative assistance, individual case reviews or insight into potential appeals.