# IRF Accounting Onboarding: Essential Document Checklist

**Date:** November 15, 2025

## 1. Introduction

To facilitate a smooth and effective transition for your new CPA partners, it is crucial to provide them with a comprehensive set of documents that offer a complete picture of the facility's financial, operational, and regulatory standing. This checklist is designed to guide you in assembling the essential materials needed for a CPA to achieve a CFO-level understanding of a freestanding Inpatient Rehabilitation Facility (IRF). The documents are organized into key areas to provide a structured and thorough orientation.

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## 2. Foundational Corporate and Financial Documents

This section includes the core legal and financial documents that define the organization and its historical performance.

| Document | Purpose |
| :--- | :--- |
| **Articles of Incorporation & Bylaws** | Provides the legal and governance framework of the facility. |
| **Chart of Accounts** | Essential for understanding the facility’s financial structure and reporting. |
| **Audited Financial Statements (Last 3 Years)** | Offers a comprehensive view of historical financial performance and position. |
| **General Ledger Detail (Last 3 Years)** | Allows for detailed analysis of financial transactions and trends. |
| **Federal and State Tax Returns (Last 3 Years)** | Provides history of tax compliance and financial reporting to tax authorities. |
| **Current Year-to-Date Financial Statements** | Presents the most recent financial performance (Balance Sheet, Income Statement, Cash Flow). |
| **Current Operating Budget and Variance Reports** | Outlines financial goals and performance against those goals. |
| **Capital Expenditure Budget and History** | Details planned and past investments in facility assets and infrastructure. |
| **Schedule of All Bank Accounts** | Provides a complete list of cash and investment accounts. |
| **Loan Agreements and Debt Covenants** | Details all outstanding debt obligations and associated compliance requirements. |

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## 3. Medicare, Medicaid, and Regulatory Documents

These documents are critical for understanding the facility’s relationship with its primary payer and its compliance with federal and state regulations.

| Document | Purpose |
| :--- | :--- |
| **Medicare Provider Number & Certification Letter** | Confirms the facility’s status as a Medicare-certified IRF. |
| **Filed Medicare Cost Reports (Form CMS-2552-10, Last 5 Years)** | The cornerstone of Medicare reimbursement and settlement. |
| **Medicare Cost Report Audit Adjustments & NPRs (Last 5 Years)** | Details the results of MAC audits and final payment determinations. |
| **60% Rule Compliance Monitoring Reports (Last 3 Years)** | Crucial for verifying the facility’s ongoing qualification as an IRF. |
| **IRF-PAI Data Submissions & QRP Reports (Last 3 Years)** | Documents compliance with the IRF Quality Reporting Program. |
| **Disproportionate Share Hospital (DSH) Calculation Data** | Supports the calculation of the low-income patient adjustment. |
| **Medicaid Provider Agreements and Rate Sheets** | Defines the terms of participation and reimbursement for Medicaid patients. |
| **Most Recent State Licensing and/or Accreditation Survey (e.g., The Joint Commission)** | Provides insight into regulatory compliance and any identified deficiencies. |
| **All Payer Contracts (Commercial, Managed Care)** | Outlines the reimbursement terms with all non-Medicare payers. |

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## 4. Revenue Cycle and Operational Documents

This set of documents provides insight into the day-to-day operations that drive revenue and patient care.

| Document | Purpose |
| :--- | :--- |
| **Charge Description Master (CDM) / Chargemaster** | A complete list of all billable services and their associated charges. |
| **Current Fee Schedules for All Payers** | Details the negotiated payment rates for all contracted payers. |
| **Accounts Receivable (A/R) Aging Reports (by payer)** | Shows the status of outstanding claims and is key to managing cash flow. |
| **Denial and Appeal Logs (Last 12 Months)** | Highlights common reasons for claim denials and the success of appeal efforts. |
| **Bad Debt and Charity Care Policies** | Defines the facility’s policies for managing uncollectible accounts. |
| **Key Vendor and Service Contracts** | Includes contracts for therapy services, pharmacy, dietary, IT, etc. |
| **Employee Roster and Salary Schedule** | Provides a detailed overview of staffing levels and labor costs. |
| **IRF-PAI Policy and Procedure Manual** | Outlines the process for completing and submitting the patient assessment instrument. |
| **Medical Records and Coding Policies** | Details the standards for clinical documentation and coding. |

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## 5. Access and Key Contacts

Providing access to key systems and a list of important contacts will significantly accelerate the onboarding process.

| Item | Purpose |
| :--- | :--- |
| **List of Key Personnel and Department Heads** | Facilitates communication and understanding of the organizational structure. |
| **Contact Information for Key External Partners** | Includes contacts for the MAC, legal counsel, and external auditors. |
| **Access to Accounting and Billing Software** | Essential for hands-on review of financial data and revenue cycle processes. |
| **Access to Electronic Health Record (EHR) System** | Provides insight into clinical documentation and its link to billing. |
| **Access to IRF-PAI Submission Software (e.g., iQIES)** | Allows for review of quality data submissions and reports. |