This is a facility certification form, not a patient form

CORFs must comply with all Conditions of Participation (CoPs) for Medicare certification

Facilities must be revalidated every 5 years through the PECOS system

RehabilitationhardDoctor signature required

Rehabilitation Unit Compliance Form

CMS-437A · CMS

Documents that a rehabilitation unit is fully equipped and staffed for hospital inpatient rehabilitation care.

Form Details

Total fields: 50
Auto-fillable: 20 (40%)
Time without BeneFill: 60 minutes
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Filled by: doctor
Frequency: annual

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Where to Submit This Form

📬

Submit to the Medicare Administrative Contractor (MAC) for the region

Submitted by the Comprehensive Outpatient Rehabilitation Facility (CORF) as part of Medicare certification.

🌐

Submit through the CMS PECOS enrollment system

https://pecos.cms.hhs.gov/pecos/login.do

Initial enrollment and revalidation submissions.

Required Attachments

📎 Completed CMS-437A (Organ-Specific Survey for CORF)
📎 Facility documentation of physician supervision and staffing
📎 Clinical policies and procedures
📎 Equipment and facility compliance documentation

Processing Time

Medicare certification surveys are conducted by the state survey agency. Processing time varies — typically 30-90 days after survey.

What Happens Next

The state survey agency will conduct an on-site survey to verify compliance. If approved, the facility receives Medicare certification to provide CORF services and bill Medicare.

Tips for This Form

✓ This is a facility certification form, not a patient form
✓ CORFs must comply with all Conditions of Participation (CoPs) for Medicare certification
✓ Facilities must be revalidated every 5 years through the PECOS system
✓ Ensure all required service disciplines are staffed and documented before the survey

More Rehabilitation Forms

IRF-PAI (Inpatient Rehabilitation Facility Patient Assessment)

IRF-PAI · CMS

Assessment instrument determining Medicare Part A FFS payment for IRF stays. Must be in the patient's medical record, dated, timed, and authenticated.

Rehabilitation Hospital Criteria Worksheet

CMS-437B · CMS

Submitted to maintain IPPS-excluded status for inpatient rehabilitation facilities.

Inpatient Rehab Pre-Authorization

Insurer-specific · Health insurance plans / UM organizations

Pre-certification for inpatient rehab admission. Must document patient can participate in 3 hours of therapy, 5 days per week (15 hours per week).

Outpatient PT/OT/ST Prior Authorization

Insurer/state-specific · Health insurance plans / State Medicaid

Prior authorization for outpatient physical therapy, occupational therapy, or speech therapy. Must specify frequency, duration, and medical necessity.

Concurrent Therapy Treatment Request / Recertification

Insurer-specific · Health insurance plans

Request for continued therapy beyond initial authorization period. Must document progress toward goals and continued medical necessity.

Vocational Rehabilitation Application

State-specific (e.g., WA DSHS 11-022) · State Divisions of Vocational Rehabilitation

Application for VR services to help people with disabilities prepare for, find, and keep jobs. Eligibility based on disability that creates a barrier to employment.

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