We are often asked questions about Medicare in all sites of service so we are putting some of the most frequently asked ones on this new page. 

We will be adding more to address our most frequently asked question. Got here through a search engine question? We will  be taking those into account as we update this page so bookmark us and visit us frequently.

Disclaimer: We attempt to keep these Q&A as current as possible, however, as regulations can change quickly, they will be as current as of the day of writing.

What will happen to the use of aides in SNF in October this year?

Where can I find more information on Medicare documentation requirements?

What can I do when the patient meets the therapy cap?

Answer: At present we are not exactly sure and really will not know this answer until the 2011 Interim Final Rule is published in April or May this year. In last years Final Rule CMS stated that aides could not provide skilled services, however, based on the regulations for counting minutes, there are times when an aide could be contributing to those minutes and not providing skilled services. For example, included in the minutes is set up time once the skilled services have been started. Thus the aide can make the therapist more efficient by transferring the patient between pieces of equipment, getting them ready for the therapist to start that treatment. This is all legal as per the instruction in the RAI Manual. Therefore if that takes the aide 4 or 5 minutes to do, that leaves the therapist free to do something more productive.

CMS stated in last years final rule that they would be looking at the use of aides and also documentation. So expect even more changes to Part A SNF coming this October.

Question: Do the Therapy caps apply to SNF part B?

Answer: The therapy caps apply to all provider types with the exception of hospital outpatient departments.

Answer: At our seminars! Actually you can download them from the CMS Internet Only Manuals website at www.cms.hhs.gov/manuals/IOM/list.asp You want Pub. 100-02, the Benefit  Manual, chapter 15, section 220. You will find everything as it relates to therapy documentation requirements.

This section is our only guidelines as there are no documented requirements for Part A services. We recommend that you follow these requirements for documentation in the Part A settings as a few years ago, CMS indicated that it would like to standardize documentation across the continuum of care.

You can also look at the information from the LCD (Local coverage determinations) of your Medicare contractor.

Answer: Supervision of therapist assistants under the private practice regulation is direct supervision by a licensed, Medicare approved therapist. Direct supervision is defines as the therapist must be in the same office suite and be immediately available to the assistant if they need direction or help. If this level of supervision is not provided, the therapist should not bill Medicare for those services.

The supervision can be provided by and licensed therapist who has a Medicare provider number, not just the one creating the POT. This is the most stringent level of supervision. ALL other Medicare provider setting require general supervision by the therapist, meaning that the therapist must be available by any telephonic means when the assistant is providing services. As always, you need to be aware of what your  practice act guidelines are and go with the most stringent.