HCPro.com - Rehab Regs

Sebelius is new Secretary of HHS

Fri, 01 May 2009 19:25:00 GMT

The Senate confirmed Kathleen Sebelius’ new position as the Secretary of the Department of Health and Human Services (HHS) with a 65-31 vote on April 28, according to The Washington Post.

Sebelius, who was the Governor of Kansas from 2003 to 2009, faced many obstacles in the journey to her new position, such as delays due to Republican opposition of her pro-life stance. However, the recent outbreak of swine flu quieted Republican resistance and hastened efforts to fill the Secretary of HHS position, according to The Washington Post.

Notice: Last issue of Rehab Regs

Fri, 01 May 2009 19:22:00 GMT

HCPro is sorry to report that this is the final issue of Rehab Regs. We thank you for being a loyal subscriber.

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Red Flags Rule guidance published

Wed, 15 Apr 2009 17:19:00 GMT

The Federal Trade Commission (FTC) published guidance April 7 to help organizations comply with the May 1 enforcement deadline on the Red Flags Rule, which forces facilities to implement a documented identity theft prevention program.

The report offers four steps to complete compliance with the rule:

Include reasonable policies and procedures to identify the “red flags” signaling potential identity theft
Design your program to detect red flags that you have identified
Spell out appropriate actions you’ll take when you detect red flags
Address how you will re-evaluate your program periodically

Read the complete FTC report.

Tips and tools for rehab professionals: Initial evaluation documentation

Fri, 03 Apr 2009 17:51:00 GMT

The initial examination is usually your first encounter with your patients, and the resulting evaluation creates a foundation for future therapy treatments. During initial evaluations, determine whether patients meet reasonable and necessary criteria for skilled therapy services. If they do not meet these criteria, it is your professional obligation to inform them that skilled therapy services are not required. Remember that the evaluation can be billed even if you don’t recommend therapy because it is needed to determine whether skilled services are necessary.

When determining whether patients meet reasonable and necessary criteria, you must do the following, regardless of the payer:

Conduct a thorough, subjective history of illness or injury, including date of onset, past medical and surgical history, medications, prior and current functional status, home living situation, and goals of therapy
Perform a thorough, objective examination, documenting baseline results
Develop a list of problems based on the results of the subjective intake and objective examination
Determine functional deficits from the examination results
Establish short- and long-term goals with expected time frames for achievement
Develop a plan of care in conjunction with the patient and his or her physician to meet those goals

This tip is from HCPro’s book The How-To Manual for Rehab Documentation, by Rick Gawenda, PT.

AOTA endorses outcomes measurement tool for occupational therapy

Fri, 03 Apr 2009 17:46:00 GMT

The American Occupational Therapy Association (AOTA) recently endorsed an outcomes measurement tool that evaluates functional improvement to help OTs improve the quality of their services.

On March 31, the AOTA announced its support for the Activity Measurement for Post Acute Care (AM-PAC), an OT outcomes measurement tool created by the Boston University Health and Disability Institute, according to an AOTA press release.

AM-PAC, which is provided by CREcare, LLC, evaluates a client’s basic mobility, daily activities, and applied cognitive functional status. The information gathered by AM-PAC will be used in AOTA’s national outcomes database for OT, and will allow therapists to track and compare the outcomes of their services, according to the AOTA press release.

Tips and tools for rehab professionals: Avoid these common pitfalls

Fri, 20 Mar 2009 14:19:00 GMT

Patients should progress and achieve the short- and long-term goals you have established with them in a reasonable amount of time. Your ongoing documentation supports the patients’ progression over this time period. The definition of “a reasonable amount of time” differs for each patient based on age, diagnosis, severity of injury/illness, and patient comorbidities, as well as many other factors.

Whatever period of time you identify for the therapy to help a patient achieve his or her goals, avoid the following common pitfalls that may lead to denials upon prospective or retrospective payment review:

Treatment that could be determined to be not reasonable and necessary for the condition or diagnosis
Services provided that could be considered repetitive in nature and not meeting the definition of skilled care
Lack of documentation to prove services rendered
Insufficient information or lack of information in the medical record
Billing errors, such as indicating the wrong place of service or billing for the incorrect code
Notes not signed/countersigned with the therapist’s or therapist assistant’s credentials

This tip is from HCPro’s book The How-To Manual for Rehab Documentation, by Rick Gawenda, PT

New specialty code for SLPs

Fri, 20 Mar 2009 14:14:00 GMT

CMS developed a new non-physician practitioner specialty code, specialty code 15, to categorize SLP services, according to a February 20 transmittal. This is an important step toward allowing SLPs to bill Medicare as private practitioners.

Providers and suppliers use specialties codes to enroll in Medicare and ensure claims are processed and paid appropriately. The Medicare Improvements for Patients and Providers Act of 2008 revised the Social Security Act to allow SLPs to apply for enrollment as suppliers beginning July 1, 2009, which is also the effective date for specialty code 15. This amendment to the Social Security Act will allow SLPs in private practice to bill Medicare directly for services provided.

Tips and tools for rehab professionals: Time management

Fri, 06 Mar 2009 20:41:00 GMT

Rehab managers are almost always faced with insufficient time in the day to get everything done. However, time management can be learned and honed through the use of various tools and by understanding the importance of following through on the plan. A skill that goes hand in hand with time management is using the delegation process appropriately and effectively. The following tangible results can occur when a rehab manager is able to manage his or her time effectively:

Improved work/life balance
Stress reduction
Improved efficiency at work
Fewer missed deadlines or appointments
Positive example of good time management to staff
Improved ability to be present and to focus on the issues at hand, resulting in more effectiveness at work

This tip is from HCPro’s book The Essential Guide to Therapy Management.

CMS delays MDS 3.0 implementation

Fri, 06 Mar 2009 16:10:00 GMT

The Centers for Medicare & Medicaid Services (CMS) announced today during the SNF Long-Term Care Open Door Forum that it is delaying the release of the MDS 3.0 until October 2010.

Rather than rushing to meet the original October 2009 implementation date, Sheila Lambowitz, director of the division of insitutional postacute care at CMS, said the agency wants to take its time and ensure that all stake holders and systems can be updated to work efficiently with the MDS 3.0.

CMS is currently working on revising the timeline and will release that in the next couple of months. But according to Tom Dudley, a CMS official, the data specs and final draft won't be released until October 2009.

The implementation delay stems from concerns that the original start date did not provide enough time for software vendors, state agencies, and other systems to properly prepare for the MDS 3.0. The MDS is a tool used by skilled nursing facilities to assess residents and determine Medicare payments.

“The delay until October 2010 is a positive thing – this gives the states, software vendors, and other stakeholders the time they need to prepare for implementation,” says Rena R. Shephard, MHA, RN, RAC-MT, C-NE, founding chair and executive editor of the American Association of Nurse Assessment Coordinators and president of RRS Healthcare Consulting Services in San Diego. “But this is also a positive for providers – it gives them they time they will need to develop and carry out a plan for training and implementation. I hope they will use it well – this advance preparation can be very important to successful implementation.”

Although professionally disappointed by the delay, Maureen Wern, president of Wern and Associates in Warren, OH believes CMS’ decision was very responsible.

“I feel that many in the industry, particularly the frontline people, were prepared to move forward. However, I certainly understand the need for the delay. If everyone isn’t prepared to do something right it’s appropriate to delay it. It was a very thoughtful decision on the part of CMS, and I’m sure it’ll prove to be the right one,” Wern says.

Long-term care professionals across the nation consider CMS’ decision to delay the implementation of the MDS 3.0 to be positive news.

“When an overhaul of such an instrumental document is being performed, it is best to ensure that it is as complete and tested as possible. This delay shows CMS is taking the process seriously and making the time to fine tune the instrument prior to implementation,” says Kate Brewer, PT, MBA, GCS, vice president of Greenfield Rehabilitation Agency, Inc., in Greenfield, WI.

Stimulus package put money into researching treatment outcomes

Fri, 20 Feb 2009 18:37:00 GMT

The $787 billion economic stimulus package, signed into law on Tuesday by President Barack Obama, will provide researchers with $1.1 billion to compare the effectiveness of different medical treatments, according to The New York Times.

This research will compare the outcomes of different treatment options, such as surgery versus physical therapy for the treatment of back pain, and determine which is more effective. In exploring the effectiveness of medications, surgeries, and other methods used to treat the same conditions, this research aims to reduce the amount of money spent on expensive, ineffective treatments, according to The New York Times.

Tips and tools for rehab professionals: Coordination of the ICD-9 coding process

Fri, 20 Feb 2009 18:32:00 GMT

Due to the size of their practice or specific internal procedures, some therapy practices may rely on administrative personnel, such as coding and billing specialists, to handle the assigning of the ICD-9 codes to therapy. This can be a helpful scenario to ensure correct coding, but can also be a potential pitfall to problems relating to ICD-9 coding. When the ICD-9 coding process is separated between the evaluating therapist and the billing coordinator, there can be potential miscommunications and inaccuracies. A concerted effort must be made to ensure that both the therapist and the coder agree that the ICD-9 codes used are the best representation of the patient’s condition, resulting in a correctly coded claim. Too often, codes are assigned strictly by a coding specialist who has never laid eyes on the patient to verify the relation of the codes to the therapist-established plan of care.

This disconnect between the billing specialist and therapist can also exacerbate misunderstandings or inaccurate coding patterns on the therapist’s behalf. For example, if a therapist is putting an expired code on a claim and the coder is correcting it prior to submission, the therapist won’t know to change the procedure unless notified of it.

Similarly, the billing personnel may also identify when a claim is missing an ICD-9 code that is necessary for the claim to process through the Medicare contractor as dictated by the local coverage decisions. The billing specialist and therapist should collaborate to identify what codes may be appropriate and seek physician input when necessary. This will serve to educate the therapist and prevent any future problems.

This is an excerpt from HCPro’s book, The Essential Guide to ICD-9 Coding for Therapy Professionals, written by Kate Brewer, PT, MBA, GCS.

Optimizing reimbursement: Tips and tools

Fri, 06 Feb 2009 16:54:00 GMT

The medical record should only contain objective, factual information that pertains to the direct care of the patient. Entries in the medical record should include:

Only the facts
Objective data without opinion or assumptions
Physical evaluation details
Details of conversations with patients, family members, and other healthcare providers
Actions taken to care for patients
Details of conversations with the physician and documentation of his or her orders or directives
Implementation of the physicians' orders or directives

This tip is from HCPro’s Pocket Guide to Therapy Documentation.

New law to license Michigan OTs

Fri, 06 Feb 2009 16:23:00 GMT

A bill to license Michigan OTs and OT assistants was signed into law by the state’s Governor Jennifer M. Granholm on January 12, according to a press release from the American Occupational Therapy Association.

The new law, which also requires OTs to take part in continuing education for licensure renewal, aims to ensure that only trained professionals provide OT services in the state. Michigan is the 48th state to license OTs and the 45th state to license OT assistants, according to the press release.

CMS announces final five MACs

Fri, 23 Jan 2009 17:55:00 GMT

CMS announced the final five Medicare administrative contractors (MAC) on January 7, according to a CMS press release. The final five MACs will begin implementation activities immediately and are expected to fully take over all claims processing work in their jurisdictions by March 2010.

In awarding the final five MAC contracts, CMS has completed the process of selecting all 15 Part A/B MACs, who will be responsible for processing all Medicare claims under the Medicare Fee-for-Service program, eventually replacing fiscal intermediaries and carriers.
The final five MACs and their respective jurisdictions are:

Noridian Administrative Services, LLC: Jurisdiction 6 – Illinois, Minnesota, and Wisconsin
National Government Services: Jurisdiction 8 – Indiana and Michigan
Cahaba Government Benefit Administrators, LLC: Jurisdiction 10 – Alabama, Georgia, and Tennessee
Palmetto Government Benefits Administrators, LLC: Jurisdiction 11 – North Carolina, South Carolina, Virginia, and West Virginia
Highmark Medicare Services: Jurisdiction 15 – Kentucky and Ohio

Optimizing reimbursement: Tips and tools

Fri, 23 Jan 2009 17:49:00 GMT

Productivity is often a source of frustration for therapists, but it is a necessary tool in measuring the business’ success. When productivity is low, examine these key areas to improve efficiency:

• Scheduling patients
• Minimizing distractions
• Documentation
• Support staff use
• Underbilling
• Collaboration
• Service delivery

This tip is from HCPro’s book The Essential Guide to Therapy Management.

New legislation would repeal therapy caps

Fri, 09 Jan 2009 17:15:00 GMT

Members of Congress introduced legislation calling for the elimination of the therapy caps in the Senate and House of Representatives on Tuesday, according to a press release from the American Physical Therapy Association (APTA).

The legislation, known as the Medicare Access to Rehabilitation Services Act, was presented by Senators John Ensign, Blanche Lincoln, Susan Collins, and Ben Cardin, and Representatives Xavier Becerra, Mike Ross, and Roy Blunt. The therapy caps have been controversial since their implementation in 1997 and many argue that they limit access to necessary treatment for seniors.

Stay tuned for more information regarding the elimination of the therapy caps and visit HCPro’s Rehab page for up-to-date news.

Optimizing reimbursement: Tips and tools

Fri, 09 Jan 2009 15:24:00 GMT

Improve your documentation with specific questions

A patient’s ability to perform activities of daily living (ADLs) is often just a generic statement in most therapists’ evaluations. Improve your documentation by asking patients specific questions regarding what ADL tasks they can perform independently and with which ADLs they require assistance since their injuries or illnesses. Specifically address the patient’s ability to do the following.

Cook and prepare meals
Complete laundry
Complete household cleaning, including vacuuming, dusting, cleaning the bathroom, etc.
Make a bed
Perform other general household task

This tip is from HCPro’s book The How-To Manual for Rehab Documentation: A Complete Guide to Increasing Reimbursement and Reducing Denials, written by Rick Gawenda, PT.

Optimizing reimbursement: Tips and tools

Fri, 26 Dec 2008 17:21:00 GMT

Prevent denials with complete home environment documentation

Obtain complete information regarding the patient’s home environment, and document it accurately. Ask the following basic questions regarding the home environment:

• How many steps are needed to climb to enter the house?
• On what floor are your bedroom and bathroom located?
• On what floor are the washer and dryer located?
• How many steps are needed to climb to the second floor?
• Are there handrails on the staircase? If so, on which side?
• Do you live alone? If you do, will you have temporary assistance while you recover? If not, is someone who resides with you home all the time or are you alone in the house for long periods of time?

If the patient lives alone but has someone staying with him or her during recovery, document that this is only short-term and that the patient will return to living alone. This accurate documentation will support your long-term goals, as well as the need for skilled therapy services. Without this clarification, insurance carriers may deny claims because they think the patient does not need to achieve independence because someone at home will help perform tasks.

This tip for optimal reimbursement is from HCPro’s book The How-To Manual for Rehab Documentation: A Complete Guide to Increasing Reimbursement and Reducing Denials, written by Rick Gawenda, PT.

Mississippi physician accused of healthcare fraud

Fri, 26 Dec 2008 16:44:00 GMT

Cassandra Faye Thomas, the owner and operator of Central MS Physical Medicine in Mississippi, was recently arrested on charges of healthcare fraud, according to a December 15 press release from the Office of Inspector General (OIG).

Dr. Thomas is accused of fraudulently billing Medicare and Medicaid $16 million for therapy services provided in patients’ homes. The therapy services in question, which Dr. Thomas billed as though she had provided or supervised, were actually provided by unlicensed and unqualified personnel with no supervision.

Alternative therapy becomes more popular

Fri, 12 Dec 2008 14:04:00 GMT

Approximately 38% of adults and almost 12% of children under the age of 18 use some form of alternative therapy, such as yoga, acupuncture, meditation, chiropractic, or herbal remedies, according to a study conducted by the National Institute of Health (NIH).

The study, which was released on December 10, found that if a parent or relative engaged in some form of alternative therapy, a child would be five times more likely to do so, according to The Wall Street Journal. The study also found the use of acupuncture, deep breathing exercises, massage therapy, meditation, and yoga has increased over the past five years.

To view the complete report of the study, visit http://nccam.nih.gov/news/2008/nhsr12.pdf.