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 for everyone, or each patient is different based on the day they were evaluated?Is this different with Part B and Home Health?

Answer:
The “Medicare Week” has been a myth for a very long time. You will hear all sorts of answers from Monday to Sunday; Saturday to Friday; and Sunday to Saturday. Most of these weeks were based on work pay periods not Medicare’s definition.

With the advent of the Change of Therapy (COT) OMRA, the whole picture changed for Part A timeframes. At one time, it was considered as 7 consecutive days starting with the day of admit (for nursing purposes) or evaluation for therapy. With the RUG IV system and the requirement to perform an assessment to see if a COT needs to be done, that essentially changed, although, if you have an order for 5 days a week, it essentially is 5 days out of 7 and does not have to be sequential.

So let’s look at an example. The patient is admitted on a Monday and is evaluated by a therapy discipline on Tuesday, the POT indicated 5xwk and the ARD for the 5-day MDS is set for Day 8 of the stay. Therefore the patient is seen Tue. Wed. Thurs. Fri. Mon. (meets the POT). Then, under the MDS 3.0 rules the COT period starts on the Tuesday and so the patient must be seen 5x before the COT ARD.

Therapy continues at the Mon-Fri schedule. The next COT is due on the following Monday (day 15), The COT and 14-day are combined, setting the 7-day COT period for Tuesday thru Monday, followed by the next 7-day COTs.

The MDS co-coordinator then set the 30-day MDS for Day 31 thus changing the COT schedule. However, because the therapy department still follows the Mon-Fri schedule, the changes based on the MDS do not affect the 5xwk POT.

Now let’s say that the patient was seen on day 1 and the 5-day was set for Day 5. This would be the scenario.

So by keeping to your 7 consecutive day period from the day you do your evaluation, you should be compliant with both your POT frequency and the COT requirements.

The problem has come from when people look at the week being Sunday thru Saturday believing they can see the patient 5 x in that timeframe. So let’s look at this concept with the same scenario.

Here, we know have 6 days in the observation period which could cause the RUG to be inflated and we are out of compliance with our plan of 5-days week (5 out of 7 days)

Go to a Tuesday admit with treatment starting on Wednesday and we get 7 consecutive days of treatment on the MDS

Now as to Part B, it follows the rule of X out of 7 days starting with the day of evaluation and HHA write orders for the initial week to be the number of days in their work week, then back to the Monday – Sunday schedule (generally). So orders could be written 1x1wk, 3x 4wks.

I hope this help to clarify this question, a little long winded but you should get the picture.

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