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IRF: Rehabilitation Physician Review Template

$ 99.00

The Rehabilitation Physician Review Template was designed to provide your rehabilitation physicians with valuable feedback and an "assessment" of their compliance with the documentation requirements outlined in the Medicare Benefit Policy Manual. The document is designed to be completed electronically. If you do not want to complete the form electronically, you can print it as a blank document and complete it in hardcopy format.

Physician documentation is evaluated by conducting a chart review that compares the specific content of the physician's documentation in the patient's medical record to CMS's criteria for each item. The document uses the following scoring matrix:

  • Well-Documented (2, 3, or 4 points): The physician provided documentation that completely and full satisfies the criterion. 
  • Opportunity for Improvement (1point): The documentation satisfies the criterion to some degree, but it should it more clearly, provide more detail, or relate to the specific needs of the individual patient.
  • Not Addressed (0 points): The criterion was absent or not met at all.
  • Does Not Apply (equivalent to the points for "Well-Documented"): Because the criterion did not apply to this patient, no documentation was necessary.

The Total Points field on the last page is based on a maximum score of 100. If you are using the file electronically, the form will calculate this score automatically as you conduct the review. The form includes fields for the reviewer's signature, the date of the review, the signature of the physician who was reviewed, and the date on which the findings were discussed with the physician.

Each section provides space for the reviewer to record comments and to identify areas of opportunity for physician education. Additional comments will be especially important for those items that were scored 0 or 1. These fields are intended to facilitate communication with the physician regarding the findings of the review.

Please note: After purchasing, the download will begin automatically and can take several minutes. You will receive an email once your download is ready.