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Medicare
News and Rules for Therapists
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Encompass Consulting & Education, LLC<=
/strong> E-Newsletter
February
2010 =
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; Vol
5, Issue 2
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![3D"Join](3D"http://img.constantcontact.com/letters/images/1101093164665/=) =
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Dear Pauline,
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![3D"Pauline](3D"http://origin.ih.constantcontact.com/fs035/1101399613904/img=)
Well I didn't quite make the February delivery =
date
as I was waiting for Congress to make their mind up about the =
Cap
Exception process. However as of today, Feb 28, there has been no
action. See "News
You Can Use" for more information. =
For our first ever survey last month there was a
reasonably good response. Being new to this form of survey, I
didn't realize that the responses would be anonymous therefore you =
will
be receiving an invitation from me to complete the
February survey. I have reported last month results in&nb=
sp;"Surveys with YOU in mind". I
also have started to implement some of the recommendations
received from that survey for enhancing YOUR Newsletter. Thanks to a=
ll
of you that took the time to respond to last month's survey. <=
/o:p>
Wouldn't you know that as soon as I wrote that the C=
ERT Contractor
was no longer publishing their national report, they did! I wander =
if
it was in response to the fact that the Office of the Inspector Gen=
eral
(OIG) had one of the Zone Program Integrity Contractors (ZPIC) perf=
orm
an audit of their audits, WOW. The report from the OIG was
that they felt that the CERT contractor was missing some =
of
the errors and therefore was under reporting the error rate. See &q=
uot;Update on Medical =
Review
Activities".
"Tip of the Month"
is the second part of last months article, "Cert Contractor Denials"
with suggestions on how you can avoid some of the most co=
mmon
reasons for denials.
In our Q&A
section I will be addressing areas of interest to both SNF and
Outpatient providers. (Another suggestion followed.)
Please feel free to forward this Newsletter to anyone
you belived would be interested in its content. Please use
the link at the end of the newsletter to forward to a friend. This =
way
we can keep track of forwards and improve our content.
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News You Can Use=
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There
are no additional guidelines from the last issue unless the exception
process is approved. Some companies are continuing to treat patients =
with
the vision that Congress is finally going to pass both the exception =
process
and the continued implementation of a 0% reduction in the fee schedule
from 2009.
Visit
our website through the Quick Links above for the article on how to d=
eal
with the caps if you did not receive last month's Newsletter.
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Update on Medical Review Activities
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The
CERT contractor issued a national error report, something it had not =
done
for more than 18 months (as reported in our last newsletter). In the =
new
report, the overall error rate had increased from 3.6% in May 2008 to
7.8% in November 2009. This change was a result of the CERT contractor
following the more stringent guidelines adopted by CMS and its other
contractors. The major providers hit with the largest increase were D=
ME
(51.9%) and Physician's services (9.9%). There was no breakdown of
individual services as in prior years so I am unable to give figures =
for
SNF and Part B services.
The
reasons for denial remain close to those I published last month with =
the
major difference being that insufficient documentation increased from=
0.6%
in 2008 to 1.9% in 2009 predominantly due to the contractor following=
the
"legible identifier" for the provider signature. This is
turning into a big denial reason.
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<=
b>Surveys with YOU
in mind
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First of all =
a BIG Thank You<=
/em>
to those of you who completed our survey in January. You views and
comments have been noted and I will work to integrate them over time.
Here are the results of the survey:
- 55% wanted the Newsletter
monthly, so I will continue with that schedule.
- 80% read more than 3/4 of the
Newsletter. Thank you so much.
- 75% were extremely satisfied =
with
the content and the rest were somewhat satisfied. Glad I can help
you navigate the Medicare Maze.
- 85% found the information very
relevant to their practice. Wow!
- 55% indicated that the optimal
day to receive the newsletter was Monday. 55% indicated that the
morning was the best time to receive it. Based on that input, we
will be sending the newsletter to reach your mailbox on a Monday
around 11 am. We are still not sure of the sending date but we a=
re
looking at the 3rd Monday of the month. More on that next month.=
<=
span
style=3D'font-size:10.0pt;font-family:"Tahoma","sans-serif";color:#39=
5D87'>And
finally, there were 2 of the responders that indicated that they woul=
d be
interested in providing content. Unfortunately, I didn't get their e-=
mail
address so would you please contact me directly at pmfr=
anko@encompassmedicare.com
Instead of including the survey in the Newsletter, I w=
ill
be sending you a direct invitation following the distribution of the
Newsletter. This is so that I can identify who has contributed and re=
ply
if necessary to any of your comments. This month's survey will assist=
me
in designing our seminars and our future Webinar. Thank you in advance
for taking the time to complete it and that should only take less
than 5 minutes of your time.
If you prefer to remain anonymous, you can go directly=
to
the survey from the following link.
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<=
b>Tip of the Month
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<=
span
style=3D'font-size:10.0pt;font-family:"Tahoma","sans-serif";color:#39=
5D87'>
<=
span
style=3D'font-size:10.0pt;font-family:"Tahoma","sans-serif";color:#39=
5D87'>Last
month we identified ten top reasons for Medicare denials. This m=
onth
we have the suggestions for ways to reduce your risk of den=
ials
on Medical Review.
<=
span
style=3D'font-size:10.0pt;font-family:"Tahoma","sans-serif";color:#39=
5D87'>
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<=
b>Q&A for SNF
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Question:
<=
span
style=3D'font-size:10.0pt;font-family:"Tahoma","sans-serif";color:#39=
5D87'>
I was wondering what Medicare defines as a patient
reaching plateau in a SNF setting? Is there a length of time a person
stops making any progress in therapy that it is justified to discharge
from skilled therapy services? Also how often is it required to screen
long term residents for ROM or is this the responsibility of nursing/=
MDS?
<=
span
style=3D'font-size:10.0pt;font-family:"Tahoma","sans-serif";color:#39=
5D87'>
Answer:
<=
span
style=3D'font-size:10.0pt;font-family:"Tahoma","sans-serif";color:#39=
5D87'>
Medicare defines it as no progress being made and that
would be very specific to each patient. It takes into account acuity,
co-morbidities etc, and whether you have made any changes to your
treatment because of the lack of progress. So there is no time frame =
to
go by, just your professional judgment and quality of documentation.<=
o:p>
As to your second question, absolutely it is the
responsibility of NURSING. Therapy got into the habit of doing that in
the '90s because contract companies got paid by the time therapists s=
pent
in a facility (and the facility got to recoup all of that money). The
quarterly screening is of no use as it should be just a review of the
chart to see if there is anything that would warrant an evaluation!
Referrals for therapy should start from nursing, either
during the residents stay or through the care planning when the resul=
ts
of the MDS should be reviewed.
<=
span
style=3D'font-size:10.0pt;font-family:"Tahoma","sans-serif";color:#39=
5D87'>
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Q&A for Outpatient Part B
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Question:
<=
span
style=3D'font-size:10.0pt;font-family:"Tahoma","sans-serif";color:#39=
5D87'>I
have been on your website and reading your advice on the Advance for =
PT
website and have found it very helpful, however I have a question in
regards to a Medicare eval for outpatient private
practice clinic in Ohio that I could not find an answer to.
<=
span
style=3D'font-size:10.0pt;font-family:"Tahoma","sans-serif";color:#39=
5D87'>
<=
span
style=3D'font-size:10.0pt;font-family:"Tahoma","sans-serif";color:#39=
5D87'>Do
I need to have actual certification dates on my eval sent to the
referring Dr. like the old 700 forms or just go by the 90 day
certification? For example, if I eval a patient on 2/1/10 and want ha=
ve a
plan of care for 3x/week x 6 weeks. Do I need certification dates on =
the
eval designated as plan of care certification 2/1/10 to 3/15/10. =
; Or
is my frequency and duration along with eval date considered enough f=
or
certification? and if I have a plan of care for 6 weeks designa=
ted
on my eval, do I need to do a re-certification at the end of 6 weeks =
or
wait until the 90 days as long as I am sending a progress note every =
10
visits or 30 days?
<=
span
style=3D'font-size:10.0pt;font-family:"Tahoma","sans-serif";color:#1F=
497D'>I'm
glad you read our column. The answers to your questions are: &nb=
sp;
- There is no such thing now as=
a
certification period. Medicare has changed it to a certification
interval and has defined that as the longest time on the POT.
Therefore, in you example you have either 18 treatments or six w=
eeks
to achieve your goals, which ever takes the longest. So if your
patient missed two visits in the 6 weeks then the longest time w=
ould
be to reach the 18 treatment. At this time you would re-cert the
patient by developing a new POT to send to the physician for rev=
iew
and approval.
- You do not have to send the
progress note to the physician unless they want to see it. The 10
visit/30 day note is to relate all of the progress made by the
patient, why you are still continuing with care and what you are
planning to achieve during the next progress report period.
<=
span
style=3D'color:#395D87'>
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&nb=
sp;
Medicare News and Rules for therapists is brought to y=
ou
by Encompass Consulting & Education, LLC. A therapist owned compa=
ny
specializing in Consulting & Educational services for therapists =
and
other professionals providing Medicare services in SNF, Rehab Agencie=
s,
Private Practice and Hospital Outpatient clinics.
Pauline M. Franko, PT, MCSP is owner and CEO of the
company and is also known as the "Medicare Advisor" columni=
st
for the "Advance for" family of News Magazine providing ans=
wers
to Medicare questions for over 10 years. She also acts a resource for=
the
respected Eli Reports and matters concerning rehab services and Medic=
are.
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&nb=
sp;
Thank you so much for subscribing to our Newsletter.
Please feel free to forward this to anyone you believe would be
interested in receiving news about Medicare. Please use the link belo=
w,
as this way we are able to track how many of you are forwarding it to
your friens and associates.
Pauline Franko
Encompass Consulting & Education, LLC
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