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See our answers below to the most popular questions each month!
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(November 2017 – Lindsey, MDS Coordinator)
Q: I’m in NYS and have a Case Mix question. When we fill out Section S of the MDS, we have to select if a resident is Managed Medicaid, Medicaid, etc. Which selections “count” in the Medicaid Case Mix?
(November 2017 – Beth, Rehab Manager)
Q: Do SNF’s get reimbursed in any way for PT, OT or SLP Evaluations for a new admission covered under Medicare Part A? Our administrator is saying yes but I can’t find this information anywhere. Can you clarify whether SNF’s get reimbursed a separate rate for doing a therapy eval for Med A?
(October 2017 – CB, Rehab Manager)
Q: Can you point me in the right direction where to find the “regulation/rule” that alarms are considered a restraint?
(October 2017 -CB, Rehab Manager)
Q: I’d like to propose to the owner of our facility (SNF) to purchase an estim and an ultrasound machine. Can you point me in the right direction where to find information regarding the monetary reimbursement of these modalities??
(September 2017 – Beth)
Q: How does a therapist “pick” the right medical ICD-10 code in the SNF? Does it have to match the MDS? Can it be different? Therapy picks their treatment code without issue based on the patient presentation, but there is question about the medical diagnosis we have to enter on our plan of care. Facility position is that the therapy medical diagnosis must match whatever the MDS coordinator picks as the primary diagnosis. Sometimes the code MDS picks is not available in the rehab software. Help!
(August 2017 – Donna – RD)
Q: Can you please tell me what the regulation is on initial MD orders. I understand we have 30 days for signature on plan of care, but what is the time frame for eval and treat orders-how long do we have for the doctor to sign? I am being told 48 hours. And I looked at the SOM pub 100-02 chapter 15 section 220 and 230 but still unclear.
(July 2017 – CC – DOR)
Q: In preparation for an OMIG audit we noted a MD order for “OT Evaluate and Treat” is missing. Is there anything the facility can do to fix this?
(June 2017- Pasaan – DOR)
Q: Can you clarify when Section O requires dashes in the Therapy End Date question? Our software automatically puts the last treatment date in this box and sometimes we have to edit this, especially if it is a “Short Stay.”
(June 2017 – Jessica – SLP DOR)
Q: Do the Medicare A regulations state anywhere that the minutes for a Rehab RUG score can’t be exact – For example, does it say somewhere that a RU can’t be 720 minutes exactly? If so, where can I find this?
(May 2017 – Kyle -OT Manager)
Q: Can a resident on Hospice receive therapy?
(April 2017 – Rehab Manager)
Q: What’s the APTA and AOTA policy on when a therapist has a student? Can the student take over the therapists caseload and the therapist take on more patients that they would then treat? How does the level of supervision work? My understanding is as long as the therapist is in the room supervising the student the therapist can be treating another patient. This also would increase the therapist’s productivity to over 100%, is this a problem? or justifiable?
(March 2017 – Kelly, SLP Rehab Manager)
Q: Is documenting total treatment minutes and CPT codes every day enough for Medicare Part A requirements?
(February 2017- Jill, PT)
Q: Do Medicare Part A progress notes need to be done weekly?
(February 2017 – PB, Rehab Manager)
Q: I have worked for many therapy companies and they seem to all say something different about therapy orders. Some companies allow and or request that therapist write the orders for a range ex 5-7 x a week and other companies say that is a “flag” for medicare and can cause a denial in payment. Can you please let me know which is correct?
(January 2017- MC, Rehab Director)
Q:What is the accurate billing approach for allocating evaluation time vs. treatment time? Is it acceptable practice to designate evaluation minutes for the initial portion of the evaluation session and “diagnostic treatment” minutes for a majority of the time using treatment codes? Are there regulatory differences between Medicare A and Medicare B?
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*Please note that when we receive multiple questions about the same topic (and we do!), we select one question and answer to post here to represent all questions submitted for that category. However, each Member submitting a question will receive a personal email response!