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Encompass 2009<=
/span>
![3D"Pauline](3D"December_08_files/image004.jpg")
We
have finalized our 2009 dates and locations for Medicare Made Easy for
SNF. We are doing something a little different and presenting the
seminars during the week instead of on the weekend.=
Here
is our schedule.
Ft
Lauderdale, FL: February 2 - 3
Tampa
/ Brandon, FL: February 5-6
Dallas,
TX: March 2 - 3
San
Antonio, TX: March 5 - 6
San
Diego, CA: March 30 - 31
San
Jose, CA: April 2 - 3
Columbus,
OH: April 30 - May 1
Chicago,
IL: May 4 - 5
Nashville,
TN: August 20 - 21
Macon,
GA August 24 - 25
St
Louis, MO: September 21 - 22
Omaha,
NB: September 24 - 25
Worcester,
MA: October 19 - 20
Cherry
Hill, NJ: October 22 - 23
West
Palm Beach, FL: Nov 9 - 10
Orlando,
FL: November 12 - 13
Our
class size is limited so make sure you register early. Visit our webs=
ite
for more information
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Dear Pauline,<=
/span>
Another year is coming to its close and I think most of =
us
are asking "where did all the time go?" I know I am. 2008 h=
as
been very good to Encompass; we have had good attendance at our semin=
ars
and our list of facilities and clinics using our services has grown. I
want to thank all of you that used our services this year, without yo=
u we
would be nothing.
At this very special time of year I personally want to w=
ish
you and your families a joyous holiday season and a healthy and
prosperous New Year.
We will be closing down our office for Christmas and New
Year but will be in contact with everybody through our virtual office=
via
the Internet. and also our website.
Thank you for your subscription to "Direction On
Demand", a free e-zine from Encompass Consulting & Education,
LLC.
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| · Q&A=
: Can
I continue to see a patient under Part B when the cap has been met?
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Question:
We have a pati=
ent
on caseload (PT in the home) who we started seeing 3 weeks after his =
CVA.
We have been seeing him 3X wk for 3 months. He wants to continue PT a=
nd
getting to a hospital is difficult for him as his wife works everyday.
What do you suggest? Will Medicare deny payment if we continue to see=
him
even 2X wk? Do they make exceptions for patients who cannot get to the
hospital outpatient clinic? Can we get preapproved as he is making
excellent progress.
Answer:=
Under the
regulations for the therapy cap exception process, you can continue to
see him as long as he is making significant improvement. The patient =
does
not have to go to the hospital for treatment. You can continue to see=
him
and add the KX modifier on the bill. You can take him down to twice a
week if you choose, but I would write a progress report probably ever=
y 2
weeks to justify this level.
In the transmi=
ttal
in May, CMS is leaving frequency to the judgment of the therapist, not
the Medicare contractor.
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| · Q&A=
: Can
SLP do cognitive training in SNF?
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Question:
Can speech the=
rapy
do cognitive retraining in a skilled nursing facility: example: stroke
with cognitive concerns re:retention of skilled PT instruction and ca=
rry
over. Could ST evaluate to determine cognitive ability and assist with
skilled training of sequencing for functional task in conjunction with
other therapies? This would benefit PT to assess and set appropriate
goals that the resident would be able to achieve. <=
/span>
Answer:=
Medicare looks=
at
speech performing cognition in relation to linguistics, not pure
cognition which it places in the OT hands. Therefore I would say that=
, in
the circumstances you describe it could probably be appropriate. One =
of
the goals that we have for Speech is that the patient will obtain the
ability to communicate regarding their own health, communication being
both receptive and expressive.
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| · News Fr=
om
Medicare:
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Major news this
past month has been the publishing of the 2009 Final Rule for physici=
an
fee services. In the rule CMS made changes to some of the requirements
for provision of Part B services; clarifying the certification periods
for CORF and ORF (Rehab Agencies), not necessarily good news;naming of
the MAC for Jurisdiction 14 and the appointment of the 4 permanent RA=
CS.
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| · Changes=
for
Speech-language Pathologists
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Starting July =
1st
2009, Speech-language Pathologists will be able to enroll in the Medi=
care
system as a therapist in Independent Practice, something that has been
denied to them since the inception of Medicare. This will allow them =
to
participate in the program allowed to their fellow therapist in PT and
OT. There is one flaw in the changes though, speech will still have to
share the $1840 therapy cap with PT. Oh well, you can't win everythin=
g!
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| · Changes=
for
Rehab Agencies
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Some bad news =
for
Rehab Agencies (ORF) and CORFs, the changes to the 90 day certificati=
on
interval does not apply to them! They are still under the old rules o=
f 30
days for ORFs and 60 days for CORFs.
CMS reiterated
this in the Final Rule published on November 19th. And the reason ---=
----
Conditions of Participation and State Survey guidelines have not been
changes in the appropriate sections of the Social Security Act and
therefor CMS cannot unilaterally change them. So for now, the updated=
POT
must be reviewed and certified by a physician prior to 60 days, then =
no
more than every 30 days for CORF, and every 30 days for ORFs.
There is one p=
iece
of good news for ORFs, they no longer have to provide social services=
to
their patients and can use extension locations to provide additional
services without having to have that location certified.
Extension
locations are now described as (1) A location or site from which a
rehabilitation agency provides services within a portion of the total
geographical area services by the primary site; (2) is part of the
rehabilitation agency; and (3) is located sufficiently close to share
administration, supervision, and services in a manner that renders it
unnecessary for the extension location to be independently meet the c=
onditions
of participation as a rehabilitation agency.=
Oh, I think th=
at I
forgot to say that now CORF physicians are also responsible for the
supervision of nonphysician staff!
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| · CMS nam=
es its
MAC for Jurisdiction 14
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Also on Novemb=
er
19, 2008, CMS announced it had awarded the contract for Jurisdiction =
14
(J14) to National Heritage Insurance Corporation (NHIC). NHIC will be
responsible for the workload in Maine, Massachusetts, New Hampshire,
Rhode Island and Vermont. NHIC's contract also includes the Regional =
Home
Health and Hospice Intermediary (RHHI) workload in Jurisdiction A
comprised of Connecticut, Maine, Massachusetts, New Hampshire, Rhode
Island and Vermont.
Originally NHIC
had been awarded jurisdiction 2 consisting of WA, OR, ID and AK, howe=
ver
that appointment was contested and subsequent denied. No alternative =
MAC
for J2 has been proposed.
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| · RACs
appointed by CMS then challenged! All on hold.
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CMS announced =
the
appointment of the 4 permanent Recovery Audit Contractors only to hav=
e it
challenged by two wantabe MACs who didn't get the award (one of which=
was
one of the demonstration RACs.)
Shame.
With the prote=
st
came an automatic stay in the RAC contractors work till the GAO comes=
up
with the final decision. That can take 100 days, so we're looking at
February before the RACS are back.
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| · CMS rol=
ls out
its 5 star program for SNF.
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At the December
SNF open door forum, CMS announced that its 5 star ratings for SNF wi=
ll
be available starting December 18th on the new layout of Nursing Home
Compare. The Nursing Home Compare will also display the star ratings =
for
each of three performance measures alongside the Overall Rating. Nurs=
ing
homes with five stars are considered to have much above average quali=
ty
and nursing homes with one star are considered to have quality much b=
elow
average.
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| · Our Com=
pany
|
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Direction on
Demand is brought to you by Encompass Consulting & Education, LLC=
. A
therapist owned company specializing in Consulting and Educational
services for therapists and other professionals providing Medicare
services in SNF, Rehab Agencies, Private Practice, and Hospital
Outpatient Facilities.
Pauline M. Fra=
nko,
PT, MCSP is owner and president of the company and is also known as t=
he
"Medicare Advisor" for the "Advance for" family of
News Magazines.She acts as a resource for the respected Eli Reports a=
nd
is on the editorial board of the "MDS Alert" and
"Outpatient Physical Therapy Coding Alert".
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