A CORF is a healthcare facility that provides outpatient diagnostic, therapeutic and restorative services.
Specific, medically necessary criteria must be met for Medicare to cover some of the costs that are incurred by a CORF. If that criteria is met Medicare will typically cover 80% of the costs.
CORF coverage and costs for beneficiaries on Medicare Advantage will vary but should be similar to Original Medicare.
A Medigap plan provides supplemental coverage and may pay for part, if not all, of the remaining 20% of qualified CORF costs.
After an injury, illness, or disability you may benefit by receiving therapeutic care that will help enhance, improve, and restore your functioning abilities. If your doctor believes you could benefit from this type of specialized care, you may receive a referral to a comprehensive outpatient rehabilitation facility, or CORF.
What is a Comprehensive Outpatient Rehabilitation Facility?
A comprehensive outpatient rehabilitation facility (CORF) is a healthcare facility that provides diagnostic, therapeutic and restorative services. All services are administered on-site and on an outpatient basis. Comprehensive outpatient rehabilitation facilities may sometimes be referred to by healthcare providers and patients as outpatient rehabilitation care. It is just another name for the same service.
What Services are Provided by a Comprehensive Outpatient Rehabilitation Facility?
Each comprehensive outpatient rehabilitation facility can offer its own selection of services to patients. However, in order to be classified as a comprehensive outpatient rehabilitation facility, the healthcare center must provide the following three services:
- CORF physician services
- Physical therapy (PT) services
- Social and psychological services
Other services that may be offered at a comprehensive outpatient facility include:
- Speech and language therapy
- Occupational therapy
- Respiratory therapy
Does Medicare Cover Services at a Comprehensive Outpatient Rehabilitation Facility?
Yes, Medicare does cover some of the cost of the services provided by providers at a comprehensive outpatient rehabilitation facility. However, in order for Medicare to pay for these services, very specific criteria must be met.
Medicare will cover services at a comprehensive outpatient rehabilitation facility when the following occurs:
- Services must be considered medically necessary
- Services must be provided by a qualified individual who specializes in that particular service
- Beneficiary must be under the active care of a physician
- Services must be part of a plan of care that is created by your healthcare team
- Services must have the potential to improve or restore a patient’s functional abilities
- Services must be similar to what would be provided in a hospital setting – the care does not have to be hospital-level care, but it does have to be services that would be provided in a hospital setting
- Services must be ordered by a doctor to treat a specific medical condition, illness, injury or disability
If the above criteria are met, Medicare will cover 80% of the cost of services. Certain deductibles and premiums must be paid before Medicare provides coverage.
After Medicare has paid its share, you will be responsible for the remaining 20%.
Medicare beneficiaries who are on a Medicare Advantage plan or a Medigap plan will have different coverage. The amount a Medicare Advantage plan will cover will vary depending upon your plan and the provider. A Medigap plan provides supplemental coverage and will cover some or all of the remaining 20% that you owe.
Are There Limits to How Long Medicare Will Cover Care at a Comprehensive Outpatient Rehabilitation Facility?
In order to continue to have Medicare cover the cost of services at a comprehensive outpatient rehabilitation facility, your doctor will need to recertify you every 60 to 90 days. To recertify you, your doctor will evaluate your care and progress. If it is determined that you still need care, you are showing signs of improvement or progress, and you are following your care plan, you will be recertified and Medicare will provide additional coverage for another 60 to 90 days.
How often you will need to be recertified will depend upon the services you are receiving. Respiratory therapy services need to be recertified every 60 days. All other services, such as physical therapy, doctor services and psychological services, need to be recertified every 90 days.