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Q: For a Medicare patient who went out to acute from our SNF, is it a literal 72 hours or 3 midnight rule to create a new 5 day ARD? Example: A patient was sent back to acute on Jan 26th at 2PM and came back at 1AM of 28th.“
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Q: Clarification needed! An expert in the field of “outpatient therapy” provided education stating “a new evaluation is NOT required when a patient changes insurance. How does this apply to transitions between Medicare Part A and Part B in the SNF setting? (AH, Director)
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Q: For outpatient therapy, is a physician order required? Or, is the certification of the POC sufficient? (JG, PT)
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Q: My team is struggling with understanding the DC function score and what is important to consider at eval and then DC. Do you have any resources or tools to help? (KM, Regional)
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Q: I work in a CAH with swing beds. Is there a mandatory frequency of visits or minutes needed per week to qualify for services?
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Q: How is Section GG coded when there is very little documentation in the record, or if the documentation shows a wide range of performance?
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Q: When a Part A resident transitions from Part A to Part B, is a new evaluation required? Is there a CMS policy on this?
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Q: Is a Medicare Part A resident with therapy orders for 5 days per week “allowed” to miss a visit for a Federal Holiday, or any other reason?
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Q: Is there a Medicare Part A requirement that a resident has to have at least 5 days of therapy during the initial 7 days of admission?
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Q: For Medicare Part A, can a treatment frequency range (ie: 3-5 days per week) be used, or is an order for Evaluation and Treatment sufficient?
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Q: With PDPM, can you combine therapy disciplines to cover the 5 calendar days needed for Part A, (like we could under the RUG system), or do you need to have 1 discipline providing 5 days?
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Q: Are clarification orders for therapy necessary in the SNF?
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Q: How does Medicare define “a week?” Is it Sunday to Saturday or based on the day of the evaluation, or something else?
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Q: Can you post PDPM rate charts for 2024? (Abby, SLP)
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Q: Did the supervision rules for therapy assistants change this year? (Bob, OTR)
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Q: Can you provide specifics on the new Caregiver Training Codes? (Syra, PTA)
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Q: Can any CPT Code be used for telehealth, or only certain ones? (Dev, COTA)
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Q: Is documenting total treatment minutes and CPT codes every day enough for Medicare Part A requirements? (Becky, PT)
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Q: Do we have to complete a discharge and then do a new evaluation when residents switch from Medicare A to Medicare B? (Kayla, OTR)
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Q:Will ability to use telehealth in the SNF with Part A patients continue through 12/31/24, or is it just Part B? (KM, DOR)
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Q: Can a RN provide respiratory therapy services in the SNF and the minutes be counted on the MDS? (Sue R, RN – 2023)
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Q: I know that Medicare Part B does not allow assistants to write progress notes or discharge summaries, but is it ok if a PTA or COTA does it if the PT or OT cosigns it? That’s how our software is set up. (Devon, COTA 2023)
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Q: “When a resident on caseload has a change of payer, is a new evaluation required? Asking particularly for Medicare Part A?
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Q: Can you direct me to any resources for Swing Beds in a hospital that follow the MDS and/or SNF rules?
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Q: We have a patient with CVA who is receiving Speech Therapy for swallow and language. The SLP now feels a cognitive assessment should be completed. Should she bill for the cognitive assessment even though an eval charge was submitted?” (Jeff B, PT, DOR)
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Q: I have a question regarding the BIMS. Our speech therapist is performing the BIMS in our SNF. I was told by our MDS Coordinator they can’t be done the same day the patient is admitted. Is this true? (DL, COTA/DOR)
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Q: Our therapy company is instructing us to bill a 1 time treatment with an evaluation that does not recommend therapy services in the plan of care. Is there a rule on this? (JJ, OT/DOR)
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Q: For a SNF resident to be eligible for Medicare A coverage with only skilled rehab (not nursing), is it at least one therapy discipline 5 days per week, or is it a combination of disciplines to equal 5 days per week? In other words, can be combine disciplines to cover the 5 days per week requirement? (AD, PT/DOR)
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Q: When should a re-evaluation be performed? Is there a difference for therapy evals and re-evals for Med A and Med B patients?” (Derek, PTA)
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Q: “Are there specific requirements for physician signature dates on therapy evals and orders. We realize there are for Medicare Part B but what about Medicare Part A?” (DOR PT, NJ)
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Q: Can you provide information about LCD’s (Local Coverage Determinations)? (PTA DOR, MI)
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Q: Who can complete the BIMS (Brief Interview of Mental Status) for a Part A resident? Can a PTA or COTA? (PT, VP of Operations, MI)
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Q: Can you provide information on the regulations for Restorative Nursing? I am specifically looking for information that approves Restorative Nursing and Therapy to occur simultaneously. We have always waited to refer to Restorative until after skilled therapy was complete. Our company is now requiring Restorative Nursing to begin on day 1 or 2 for our Part A admissions. (Lisa, PT OH)
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Q: Please clarify when the SNF needs to issue a NOMNC (Notice of Medicare Non-Coverage) form for Medicare Part B residents. (August DOR, PT)
Answer: Below you will find 3 references that support the answer.
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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!