Soldotna, AK: August 24th 2012

Soldotna, AK: August 24th 2012

]]> http://encompassmedicare.com/mastering-medicare-online-registration/feed/ 0 http://encompassmedicare.com/anatomy-of-documentation-online-registration/ http://encompassmedicare.com/anatomy-of-documentation-online-registration/#comments Fri, 27 Apr 2012 19:15:14 +0000 Pauline http://encompassmedicare.com/?p=1844 San Francisco, CA: July 28th 2012

Soldotna, Alaska: August 24th 2012

I am planning our webcast series that I hope to get posted in the early part of May. These series will contain some of the information in our live seminars as well or other topics. Do you have any topics you would like to be covered? Let us know and we will see if we can cover those topics.

We will be unrolling our new CQR club in the next month as well. It will be entirely different that our old membership, so get ready for that.

We are also adding the ability to register and pay for services on-line as well as by phone, fax, and mail. Our News and Rules for Therapists newsletter is scheduled to be issued in May (finally) and should get you all up to date with CMS and their changes.

The SNF seminar will include all of the new changes effective April 1st 2012.

We will be posting the rest of the schedule in the next week and we will be heading to Alaska for the end of August. Bring the family and take a cruise for labor day, that’s what we will be doing.

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 and needs to be treated with SKILLED therapy; and with this skilled therapy, there is good reason to believe that the function will improve in a reasonable and finite time frame.

That being said, if you look at section 40.2.1 b.1.i in the Chapter 7 Medicare Benefits Manual, you will see that in regards to the initial assessment:
“During this visit, the therapist must assess the patient using a method which allows for objective measurement of function and successive comparison of measurements. The therapist must document the measurement results in the clinical record.”

So what does this mean? You must be as objective and specific as possible in the areas you are going to treat in your documentation. That way, your progression will be as objective and specific as possible and not in vague terms. If you are working on range of motion of a knee for example, it would be good to include the active and passive range of flexion and extension. It would be just as important to explain WHY you need the range of motion to improve in functional terms, or this is all a moot point.

Range of motion can be described as WFL or WNL, can be described as reduced 50%, and can be given a number. However, if you are going to treat a specific area, the most specific details should be noted. In the areas that are not going to be treated, it may be more vague but to still convey a point.
No, you do not need every ROM on every joint, unless for some reason you are doing ROM on every joint. In this same manner, you would not put just gait with RW SB assist if you indeed planned on working on gait training (and not just functional balance). In this case, you would want to mention gait speed, sequencing, and words like trendelendburg gait, hip in flexion and knee valgus during stance phase, limited toe clearance due to foot drop during initial and mid swing phase, and what happens during different surfaces, as the patient fatigues, turns, backs up, etc. In fact, often times I see a ton of collected data, a lot of ROM and a grid of MMT, and 3000 other tests, but when the chart is ultimately audited, not one person can tell the real purpose of treatment without having to read between many lines.

In summary, be as specific as possible in every category you are going to focus treatment to help justify and show progression during reassessment. However, on items that are not pertinent to the case or not going to be treated, chronic, etc., there is no need to be as objective and specific in these categories. Don’t cloud up the purpose of the assessment with unnecessary data.
Hope that answers your question and good luck out there.

So what are these changes? Well they relate to combining scheduled and unscheduled assessments, consequences of early and late unscheduled assessments and inactivating assessments. Combining or not combining assessments when the ARD of the unscheduled assessment will no longer be an option. Well, it will be but with consequences.

Having an incorrect ARD for the COT and an EOT will also bring penalties that may keep on giving and giving. Then the biggest bomb, if either the AI or date of the ARD are incorrect (most of the time just an honest mistake due to an input error), then, once this is discovered, then the associated MDS must be made inactive and the replacement must have an ARD of the date the error was discovered with all new info and signatures. If the facility is not able to complete the new assessment because the resident has been discharged, the facility is now liable for coverage and cannot charge the default rate for that time.

Now, is you head spinning? I will be including this updated information in the Tampa seminar, Mastering Medicare for SNF Part A. I am also working on being able to provide a webcast for those of you who cannot make that seminar. However, other than the combined assessment policy, if you are providing the appropriate level of care for your patient AND not keeping the resident to the minimum therapy minutes for the RUG level, this should not have a huge impact!!!!
Stay tuned

See our previous post for more details of the Medicare changes.

a) Continues consistent use of the KX modifier when the cap ($1880 for 2012) is met provided the patient continues to meet the medically necessary requirement.

b) The Manual Medical Review will be reintroduced; starting on October 1st 2012, patients who have met or exceed just under twice the amount of the current cap, $3,700 in therapy expenditures will be subject to a manual medical review. The medical review will be similar to the process used following in 2006. The $3,700 threshold will be applied to both caps sperately, the combined PT/Speech cap and the OT cap.

c) Also starting October 1st, each claim must include the national provider identifier (NPI) of the physician who is reviewing the plan of care.

d) A big change for Hospital Outpatient Setting is that, for this year at least, the therapy cap along with the exception process will be applied to their outpatients.

e) No later than June 15, 2013, MedPAC shall submit to the House Energy and Commerce Committee, House Ways and Means Committee and the Senate Finance Committee a report on how to improve the outpatient therapy benefit. The report will include recommendations on how to reform the payment system so that the benefit is better designed to reflect individual acuity, condition and therapy needs of the patient. The report will examine private sector initiatives relating to outpatient therapy benefits.

e) Beginning January 1st, 2013, the Secretary (of HHS) shall implement a claims based data collection strategy that is designed to assist in reforming the Medicare payment system for outpatient therapy. (I thought this was already being done by CMS, but what do I know!). The system will be designed to provide for the collection of data on patient function during the course of therapy services in order to better understand patient condition and outcomes. In proposing and implementing such a strategy, the Secretary will consult with relevant stakeholders.

f) No later than May 1st, 2013, the Comptroller General shall issue a report to the House Committee on Energy and Commerce, the House Ways and Means Committee and the Senate Finance Committee on the implementation of the manual medical review process. The report shall include data on the number of individuals and claims subject to the process, the number of reviews conducted and the outcome of the reviews.

So we can breath a little easier. This bill is expected to pass both houses.