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Last Modified: 7/2/2018 Location: FL, PR, USVI Business: Part A, Part B

Reimbursement for CORF versus ORF FAQ

Q: Are there any physical therapy services that are considered reimbursable in a comprehensive outpatient rehabilitation facility (CORF) setting but are not considered reimbursable in an outpatient rehabilitation facility (ORF) setting?
A: No, however ORFs and CORFs are different provider types and submit claims on different types of bills. In addition, they are not part of an outpatient hospital therapy department.
An ORF is defined as a provider of service with an agreement to furnish outpatient therapy services to beneficiaries. The services must be reasonable and necessary with a potential for improvement. Only restoration therapy is covered. The beneficiary must be under the care of a physician. The facility agrees that they will not charge the beneficiary for covered services that Medicare should pay. ORFs use a 74x type of bill when submitting claims to Medicare.
A CORF is a facility that is primarily engaged in providing diagnostic, therapeutic and restorative services to outpatients for the rehabilitation of the injured and disabled or patients recovering from an illness. The CORF must provide a comprehensive, coordinated skilled rehabilitation program for its patients that include, at minimum, CORF physicians’ services, physical therapy services, and social or psychological services. The facility must have adequate space and equipment necessary for any of the services provided. In general, all services must be furnished on the premises of the CORF. The only exception is home evaluations. CORFs use a 75x type of bill when submitting claims to Medicare.
Another difference between CORFs and ORFs
For a CORF, the referring physician must review the plan of treatment every 60 days. However, an ORF must have the physician certify the plan of care every 90 days. For outpatient hospital-based therapy departments, re-certification for therapy should be performed every 90 days; however, it is acceptable for re-certification to be performed every 60 days.
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