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Team Montero
(December 2015- Sue, MDS Coordinator)
Q: If our resident goes to the hospital and is there while the 92 day mark for the quarterly comes up, what do we do? Can we wait until they are back or will this be considered late?
(December 2015- Claire, Rehab Director)
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.
(December 2015- Becky, PT)
Q: Is documenting total treatment minutes and CPT codes every day enough for Medicare Part A requirements?
(November 2015- Will, PT)
Q: Do Medicare Part A progress notes need to be done weekly?
(November 2015- Devon, COTA)
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.
(October 2015- Rachel, SLP, DOR)
Q: Can you provide a sample of ICD-10 codes that we might use for a dysphagia Med B patient?
(October 2015- Brian, PT)
Q: What is the best method to look up and assign appropriate ICD-10-CM codes?
(October 2015- Sarah, PT)
Q: For SNF’s, are we supposed to use ICD-10-CM codes or ICD-10-PCS codes, or both?
(September 2015- Kevin, PT)
Q: Is a physician order needed for a therapy evaluation for Medicare Part A? Part B?
(September 2015- Kathy, OT)
Q: Where in the regulations does it say that resident progress is not needed in order to keep a resident on a therapy program?
(September 2015 – Jill, PT)
Q: Can a facility do a Quarterly MDS more often than “quarterly?” For example, if a Quarterly MDS is done, can another one be completed sooner than 3 months (ie:1 month later)? Our facility says that “6 weeks” is the time that must be between quarterlies but I can’t find it in writing. This all has to do with our facility state case mix.
(September 2015- Karla, COTA)
Q: I am inquiring about billing. When I treat a Medicaid patient, do I follow the 15 minute rule (23-25 minutes, 38-40 minutes, 53-55 minutes) and treat them just as I would a Part B patient?
(August 2015 – Sandy, SLP)
Q: How can I find out how much each CPT Code pays per unit? Is there a list published?
(August 2015 – Jill, MDS Coordinator)
Q: How can we figure out what the Rehab RUG score will be for a “short stay” resident?
(August 2015 – Jodi -Rehab Coordinator)
Q: Can a Medicare patient be discharged home on a Monday, with rehab as their only skilled service, and not be seen by rehab on Sunday?
(August 2015 – Mark, PT, Rehab Director)
Q: Can we bill time spent delivering patient education?
(July 2015 – Krystal, PT)
Q: I am an OTR and my coworkers and I were wondering: Do we have to discharge a resident and then do a new evaluation when they switch from Med A to Med B? Is it an evaluation? Re-evaluation? or do we just keep going?
(July 2015 – Kim, OT)
Q: Can we see a Med B and a Med A resident concurrently for treatment?
(July 2015 – Chris, PT)
Q: Is a COT required if the last covered day of Med A is on day 7 of the COT cycle and this is also the last day of therapy? Our resident will remain in the SNF after therapy discharges for long term care.
(July 2015 – Amy, MDS Coordinator)
Q: We are a Case Mix state (NY). When I verify the insurance of each resident what is the criteria I am supposed to use? Is it the resident’s insurance as of the cut-off date or the resident’s insurance as of the ARD date?
(July 2015 – Sharon, MDS Coordinator)
Q: If a “Short Stay” MDS is completed and we get a Rehab RUG but therapy did not evaluate the resident until day 2 of the stay, will Medicare pay for day 1 of the stay? What would the score be? or is this default?
(June 2015 – Laura, PT)
Q: Do you have to screen each new short term rehab admission? I’ve worked for some that are very strict that you must, and others that say if they come with therapy orders you do not need to screen first. Are there any regulations that address this?
(June 2015 – Whitney, PTA)
Q: I have a patient with Parkinson’s Disease and he goes so fast with this movements. I cue him to slow down but how can I work on this?
(June 2015 – Jeff, PT)
Q: If I have a resident on skilled PT and progress has “maxed out” but I want to continue maintenance PT to prevent a decline, do I need to discharge and restart therapy or just document the change?
(June 2015 – Cynthia, PT)
Q: Can you explain co-treatments? Can PT and OT co-treat a resident every day if we need to?
(May 2015 – Donna, PT)
Q: Can my PT student bill for services they perform with a Medicare PartA resident?
(May 2015 – Michelle, PT)
Q: What should be inclued in the plan of care and does it need to be signed by the doctor?
(May 2015 – Karen, OT)
Q: Are G-Codes required for Maintenance Therapy?
(May 2015 – Ben, PT)
Q: I would like to put a resident on a maintenance therapy program. Does the resident need to have a chronic or progressive disease to see them for skilled maintenance therapy?
(April 2015 – Ben, PT)
Q: Can I put a resident directly onto a skilled maintenance program based on my initial evaluation findings?
(April 2015 – Nancy, OT)
Q: Do I have to label a resident as “restorative” or “maintenance” in my documentation?
(March 2015 – Lori, PT)
Q: If my resident is on a skilled maintenance program and I see them every 2 weeks, do I have to bill a re-evaluation for each visit to adjust the program, or can these just be treatments?
(March 2015 – Deb, Biller/Coder)
Q: Does the therapy cap apply to maintenance therapy? Skilled and Unskilled? How does that work?
(February 2015 – Susan, SLP)
Q: Can I complete a Speech Treatment and a Swallowing Treatment on the same day?
(February 2015 – Madison, PT)
Q: Can I use balance measures from a standardized test in my goals? (ie: increase the score from y to z)
(January 2015 – Ashley, SLP)
Q: I am a Speech Language Pathologist. Do I need a physician’s order to evaluate a patient? Can I write in the order section of a patient’s chart for a Speech Eval and have the physician sign it?
(January 2015- Lois, COTA)
Q: Can a COTA submit G-Codes for Medicare billing?
(January 2015 – Deb, OT)
Q: What would you recommend when OT and PT both get a consult/referral from nursing for the same issue? Transfers, for example.
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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!
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