March 12, 2012

Do I Have To Complete ROM For Every Joint?

Medicare Mentor

Question: My agency is asking me to fill in every ROM for every joint. They say I cannot write WFL or WNL or write decreased with a percentage which seems a bit tedious and unnecessary to me. What is the answer? -Frustrated in Houston, George. Answer: George, the answer is somewhere in the middle (like usual). The bigger picture you present the better. The more things you show that are wrong with a patient, the better justification. However, your main mission is to show that the impairment is affecting function …
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January 13, 2012

What constitutes a Medicare Week in SNF?

Medicare Mentor

Question: What constitutes a SNF Medicare week? I keep getting asked if there is a “Medicare week” for therapy. Some people have said if a patient comes in on Tuesday, and the frequency is 5 x a week I can treat them Tuesday through Friday then start the “Medicare week” and see them any 5 times Sunday through Saturday. I thought that if they come in on Tuesday, I need to see them five times between each Tuesday and the following Monday. What is the right way? Sunday to Monday …
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October 27, 2011

Under SNF Part A, how do I bill unattended and attended modalities

Medicare Mentor

Question: In regards to billing for attended and unattended Modalities under Med A in SNF. Under the new regulations effective October 1, 2011, do we continue to bill attended and unattended modalities as non time sensitive services? Answer: Supervised modalities such as e-stim have skilled and non-skilled components as far as Part A is concerned. The time spent in determining the appropriate placement of the electrodes, application of the electrodes and determining of the appropriate intensity is skilled. Once the intensity of application is achieved, the time spent receiving the …
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October 24, 2011

Is checking the DC planning box enough for discharge planning in Home Health?

Medicare Mentor

Question: We have been auditing our records and our consultant keeps saying we are not doing enough discharge planning. I thought if we checked the box that says DC planning is what we needed to do. What else is needed for DC planning? Answer: Your consultant is correct. It helps frame the entire case when you do proper discharge planning from day one. It should be in the evaluation and then in every subsequent note. Discharge plans should be specific and appropriate for the patient’s functional ability and living situation. …
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October 8, 2011

Can I treat patient’s with supervised modalities and have all time billable?

Medicare Mentor

Question: A modality vendor stopped in to our clinic recently and said that for Part B a therapist can apply an unattended modality (unattended EMS or diathermy) to more than one patient at the same time and all time is billable. Is this correct? Also could you run through different part B scenarios such as: 1. Therapist supervision 2 part B unattended modalities at the same time and not seeing any other patient. 2. Therapist supervising 2 part B modalities and doing manual therapy with third part B patient. Answer: …
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September 26, 2011

Can a tech treat patients under the supervision of a physician and bill Medicare?

Medicare Mentor

Question: If the outpatient clinic is being supervised by a physician is it OK for PT tech’s or aides to treat patients? If so does the therapist also need to be supervising? Answer: Absolutely NO! 1) Medicare does not pay for services provided by an aide or tech, only those of a qualified professional. 2) If a physician is billing incident-to, then those services must be provided by a physical therapist, not even a physical therapist assistant will be accepted. 3) To bill Medicare for services provided by a tech/aide …
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September 5, 2011

Do The New SNF Rules Allow Us To Get The Patient Better Than Their Prior Level?

Medicare Mentor

Question:I was informed that we can treat beyond what was there prior lever of function, I work in skilled rehab, and they said this was part of the new rules. If the patient would benefit from going beyond PLOC. Is this true? Answer: Absolutely NO. There has been no changes in the regulations on that topic AND once the patient does not require the 5 day a week intensity of the SNF Part A they need to be discharged to a lower cost provider such as HHA or Part B. …
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August 24, 2011

I Have Some Part B Questions

Medicare Mentor

Question: I have some questions for you about Part B Outpatient services: In the outpatient setting does there have to be physicians on-site and a daily “Dr. on call” that is indicated on the billing charge in order to be covered by Medicare? One of our sites does not see Medicare patients because of this reason but I don’t know that it’s a valid point. You didn’t mention it in your class. Next, is the “GP” modifier necessary for billing under each procedure? (I am not referring to the 59 …
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August 7, 2011

How Do I Count Student Minutes Under The New SNF Regulations?

Medicare Mentor

Question: Under the SNF final rule how is the following situation handled? A therapist is supervising a student (not in line of site) while the therapist is seeing another patient. How are the Part A SNF minutes applied? Do both the therapist’s patients and student’s patients minutes count as 1:1 or because the student is an extension of the therapist, are the minutes counted as concurrent. I’ve read the final rule document and am still confused. What if we have the same scenario above except that the therapists and students …
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July 24, 2011

We Have Been Told The Physician Needs To Sign The Evaluation & Progress Notes, Is That True?

Medicare Mentor

Question: I have attended several of your seminars and have learned a lot from all of them! I am the rehab director at a SNF where we are contracted in. The SNF has recently undergone an internal audit where many errors were found, and we are in the process of trying to remedy some of the problems and come up with plans of correction. Last week, our Medical Records lady went to a meeting, and one of the things she was told, which she brought back to me, is that …
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