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Most recent questions and answers below-
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(August 2019 – DOR, PT)
Q: Please clarify when the SNF needs to issue a NOMNC (Notice of Medicare Non-Coverage) form for Medicare Part B residents.
Answer: Below you will find 3 references that support the answer.
(July 2019 – Jen OTR)
Q: I am looking for clarification on the Part A PPS Medicare End of Stay assessment. Is this only required if a resident is staying in the building and not being discharged home?
Q: And are we to be completing this for our managed medicare/commercial plans as well or strictly Med A only?
Answers:
(June 2019 – RP – DOR)
Q: Is an assistant allowed to report or change Section GG ? Can they fill that section out? Rationale is that if CNA’s can report then shouldn’t therapy assistants be allowed as well?
Answer:
(May 2019 – KM – DOR)
Q: I have an OT student who would like to be able to treat independently. I understand we both can’t treat different residents and bill as individual, but can you explain how to bill if she is doing a treatment while I am evaluating? Can the student treat a Medicare Part A resident while I evaluate another, and can we then both bill individually, or is this concurrent?”
Answer:
(April 2019 – Jenn – DOR)
Q: What will the minimum requirement for therapy be under PDPM? It is my understanding it can be 5 days a week, 30 min a day, which can be done by one discipline or split between disciplines. (ie: 2 days PT, 2 days OT and 1 day SLP)
Answer:
(March 2019 – DOR – Anonymous)
Q: I attended a seminar about PDPM and have a question. The presenter stated that the “facility would get paid for therapy whether it was provided or not.” Is this true? How does this work?
Answer:
(February 2019 )
Q/A: Due to the multiple PDPM (Patient Driven Payment Model) questions flooding in, we have created a 10 minute “crash course” video to help therapy professionals get their feet wet with the topic. Please see below….
Myths, misinformation and misconception…Seems to be a lot of this going around in the SNF setting these days regarding changes to come.
Here are the Top 5 Patient Driven Payment Model (PDPM) realities as we see them today…
- The new payment model begins in the SNF setting in less than 8 months
- Many SNF therapists voice they have received little to no information on the model that they can use in their day to day practice
- Many SNF therapists have not been able to do their own research on the model yet (And how could they?….No time to spare with {crazy} productivity requirements!)
- Many therapists are receiving PDPM information from their company and/or employer, and with that may come {some} bias
- A bulk of the information therapists are receiving is not completely accurate and is causing fear, panic and misconception regarding job security and professional duties.
SNF therapists want to do the right thing! That’s how they are wired!
Therapists are seeking accurate information about PDPM and we want to help. We recognize limitations in time and $ and wanted to be of assistance by giving SNF therapists a starting point where they can see and hear factual information about the PDPM changes to come, receive unbiased information and receive resources to further their education.
That’s why we created this 10 minute crash course video to get the ball rolling for SNF therapists. Now… with that said, no one who is serious about learning should ever get their full education from a crash course! This is just a starting point in which therapists are expected to build upon.
But you have to start somewhere, right? And 10 minutes of your day is not going to break you!
Watch the video….ask questions….do your own research!
We also have a “real” PDPM training course that can be found by clicking HERE This comprehensive course is 5 contact hours and includes case examples to calculate the PDPM vs RUG-IV payment rates. $149 for Members.
(January 2019 – Ryck – DOR)
Q: Are there any “free” resources out there to help with Section GG coding for Self Care and Mobility?
A: Yes! Here are a few to get you started.
CMS Training Video Series for Section GG
This is a “at-your-own-pace” training that goes through all of Section GG. Case examples are provided and you can code questions based on scenarios given, and then check your answers.
GG Self Care and Mobility Coding Decision Tree
This is a PDF 1 page decision tree to help you select the best answer for “helper assist” for all Self Care and Mobility questions.
SNF Quality Reporting Program Training Homepage – CMS
Section GG is part of the SNF QRP. The CMS home page is a good place to keep up to date on any new information released and/or review resources.
Article explaining SNF QRP and other Section GG factors new for 2019
Good Luck and if you have any questions, Just Ask!
(January 2019 – Deb – Billing Supervisor/Finance )
Q: We have just been notified that a few residents dropped their Medicare Advantage Plan on January 1st and switched back to traditional Medicare Part A. We want to bill Medicare for the days in January and need a PPS MDS to do so. Our MDS Coordinator is stating that she can’t create a PPS MDS now because it is too late. Please advise.
Answer:
(December 2018 – Michelle OT/DOR)
Q: Who should be responsible for filling out Section GG of the MDS, therapy or nursing? Our therapy software populates the MDS from our evaluations but sometimes the MDS Nurse changes the data in GG. Are there specific rules around this?
Answer:
(December 2018 – Eric – SNF Outpatient Mgr)
Q: I understand that we will not need to use G-Codes for Medicare Part B therapy in 2019. My question is, does this apply to situations involving residents in a SNF receiving Medicare Part B therapy AND patients who come to the SNF’s outpatient clinic, or only outpatient?
Answer:
(November 2018 – Denise – MDS Coordinator)
Q: We are trying to determine if there are specific requirements for signature dates on therapy evals and orders. We realize there are for Medicare Part B but what about for SNF residents?
Answer:
(October 2018 – Bob – OT and Jess – DOR)
[We included both questions here as the topic was the same. The answer provided applies to both questions.]
Q: Can a therapy assistant do any part of the discharge summary or progress report? For example, can an assistant address the goals ?
Q: I was always taught that a COTA and PTA could write the subjective and objective part of a progress note. The assessment and modification of the plan needed to be completed by the PT and OT. Is this accurate for Medicare Part A and HMO?
Answer:
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