Therapist Toolbox – Table of Contents

Manuals:

• Summary:
  • Explanation of Manual Set Up and Content

• Medicare Part A Rules : 
  • SNF  | SNF Explanation of Content
  • Inpatient Rehab |  Home Health
  • Hospital Inpatient
  • Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

• Medicare Part B Rules (SNF, Hospital Outpatient)
  • Part B Explanation of Content
    • Evaluations | Progress Reports | Daily Treatment Encounter Note
    • Re-Certifications | Discharge Reports

• State Operations Manual (Updated 11/22/17)
  • Major Manual Update – New F-Tag Labels (Index)
  • CMS Transmittal November 2017  – All new F-Tags
  • Key Components for Therapists  (Pre-2017 update)

• RAI Manual
  • Final RAI Manual for October 2019 – Released May 2019
  • For all PDPM content go to PDPM Resource Center HERE
  • Technical Specifications MDS – Home Page
    • DRAFT MDS Data Specs for 10/1/19 (Released 2/5/19) Zip File
  • See below for DRAFT Item Sets for 10/1/19 (Released 1/19)
  • Final RAI Manual for October 2018 – Released August 2018
    • New Manual Pages
    • Item Set Changes (zip file)
    • New MDS:  Comp  |  Quarterly  |  PPS  |  NPE Part A PPS DC
    • New Section GG Updates 10-1-18
    • Section GG Self Care and Mobility Decision Tree
    • CMS Section GG Coding Tutorial
  • Final RAI Manual for October 2017 Released August 2017
    • New Manual Pages (439 total)
    • New Item Sets:  Comp  |  Non-Comp  |  PPS
    • What’s New?
  • RAI Manual for October 2016 Released 8/25/16
  •   8/10/16 CMS posted the new MDS 3.0 item sets (assessment forms) v1.14.1. These will go into effect 10/1/16.
    • PPS 5,14,30,60,90 Day  |  Quarterly  |  Comprehensive  |  Part A Discharge |  Facility Discharge
  • *Draft RAI Manual for October 2016 Release
  • MDS 3.0 Manual (Updated 10/2015- zip file)
  • Replacement Manual Pages (Updated 10/2015- zip file)
    • Explanation of October 1st 2014 Changes
    • CMS COT Clarification Memo
    • COT Case Examples

• Coding
  • ICD-10-CM Tabular List of Disease and Injury from CMS.gov
  • ICD-10-CM Index List of Disease and Injury from CMS.gov
  • ICD-10 Code Look-up Tool from CMS.gov

• Quality Measures
  •  CMS QM Home Page
  • QM Users Manual – 4/1/17
  • Cheat-sheet for: QM – 5 Star – Nursing Home Compare – Survey

• SNF Quality Reporting Program
  • CMS SNF QRP Home Page
  • SNF QRP Measures and Technical Information – Summary Page
  • SNF QRP Users Manual 10/1/18 (Measures & Calculation)
  • SNF QRP Change Tables (2018)
  • SNF QRP Technical Specifications for Measures FY2019
  • SNF QRP FY2020
  • SNF Quality Reporting Users Manual 2017

• SNF Value Based Purchasing
  • CMS SNF VBP Home Page
  • SNF VBP FAQ Document – June 2018
  • SNF VBP Score Overview – CMS YouTube Video
  • CMS – Accessing SNF VBP Confidential Reports – Instruction
  • SNF VBP – Understanding Confidential Feedback Report

• Nursing Home Compare

MDS 3.0 Resources:

• Final RAI Manual and Documents for October 2019: 
  • MDS-3.0-RAI-Manual-v1.17.1_October_2019-Released 9/18/19
  • MDS 3.0GeneralChangeTable_v1.17 to v1.17.1 [PDF, 126KB] – Released 9/18/19
  • MDS 3.0 RAI Manual v1.17.1 Replacement Manual Pages and Change Tables_October 2019 [PDF, 16MB]-Released 9/18/19
  • MDS 3.0 RAI Manual v1.17.1 and Change Tables_October 2019_Part_2 [ZIP, 12MB]-Released 9/18/19
  • MDS 3.0 RAI Manual v1.17.1 and Change Tables_October 2019_Part_1 [ZIP, 15MB]-Released 9/18/19
  • MDS 3.0 RAI Manual v1.17.1 and Change Tables_October 2019_Part_3 [ZIP, 9MB]-Released 9/18/19
  • MDS3.0_Final_Item_Sets_v1.17.1_for Oct_1_2019 [ZIP, 4MB]-Released 9/18/19
  • RAI Manual for October 2019 – Released May 2019 (Revised version above)
• RAI Coordinator By State – Released 2019
  • • Updates to RAI Coordinators – Released 8/19
• For all PDPM content go to PDPM Resource Center HERE
• Final RAI Manual for October 2019 – Released May 2019
• DRAFT Item Sets for 10/1/18 **Released January 2018
  • PPS 5 Day
  • NPE Medicare Part A PPS Discharge
  • Comprehensive
  • Quarterly
  • OBRA Discharge
  • IPA (Interim Payment Assessment)
  • OSA (Optional State Assessment)
  • Item set Changes –  Tables
  • Section GG Self Care and Mobility Decision Tree
  • CMS Section GG Coding Tutorial
• **MDS Changes for Oct 1 2018
  • 5 Day PPS MDS (10/1/18)
  • PPS Discharge (10/1/18)
  • Comprehensive
  • Quarterly
  • OBRA Discharge
• CMS Q&A Fact Sheet on 10/1/16 MDS Changes and QRP
• Section GG: Admission/DC Self Care & Mobility Data Collection Tool
• Section G Balance and ROM
  • Interpretation of Section G: Balance and ROM
• MDS 3.0 Forms: Quarterly, Comprehensive, PPS, SOT, OMRA, Discharge , Part A Discharge
• Section O Therapy Days and Minutes
  • Interpretation of Section O: Therapy Minutes, Days and Dates
• Section O: Restorative Nursing
• Respiratory Therapy MDS Audit Tool
• PPS MDS Short Stay Algorithm (Updated 10/2015)
• PPS MDS and Payment Schedule
• ADL Score Determination  |  Algorithm  |  Calculation
• PPS MDS COT Algorithm
• MDS Correction Algorithm

Reimbursement – Medicare Part A:

• For all PDPM content go to PDPM Resource Center HERE
• 2020 SNF PPS Final Rule – Released 7/30/19
• 2020 SNF PPS Proposed Rule – Released 4/19/19
• 2019 SNF PPS Final Rule (FY 2019) Released 7/31/18
  • *Includes Patient Driven Payment Model for 10/1/19
• 2019 SNF PPS Proposed Rule (FY 2019) Released 4/27/18
  • New Part A Payment Model Proposed for 10/1/19 – Patient-Driven Payment Model
    • Home Page
    • Rule/Document
    • Acumen Technical Report
• Archived SNF PPS Final Rules
  • 2018 SNF PPS Final Rule (FY 2018)
  • **New 4/28/17 – Proposed SNF New Payment Model – No RUGS
  • 2018 SNF PPS Proposed Rule (FY 2018)
  • 2017 SNF PPS Final Rule (FY 2017) PDF Version
  • Urban and Rural Rates 2017
  • 2017 SNF PPS Proposed Rule (FY 2017)
  • 2016 SNF PPS Final Rule (FY 2016)
  • 2016 SNF PPS RUG IV Rates
  • 2016 SNF Proposed Rule
  • 2015 SNF PPS RUG IV Rates
  • 2015 SNF PPS Final Rule (FY 2015)

• PPS MDS and Payment Schedule
• Advanced Beneficiary Notice:
  • CMS-R-131 | Denial Letters | SNF ABN  10055
  • NOMNC 10123 |  DENC 10124 |  NEMB SNF 20014 (Discontinued 2018)
  • Breakdown of Requirements for each form

• What is Skilled Therapy Fact Sheet
• SNF Billing Fact/Reference Sheet
• SNF Part A Certification and Recertification Requirements (for SNF stay)
• Therapy Schedule and Minute Tracker (sample)
• PPS 100 Day Tracker Sample 1  |  Sample 2
• MDS Therapy Data Sheet
• Statistics and Report Forms
• ICD-10-CM Code List: LTC Therapy Most Common Codes (New 10/1/15)
• ICD9 Code List: LTC Therapy Most Commonly Used Medical Dx
• ICD9 Code List: LTC Therapy Most Commonly Used Treatment Dx
• CPT Codes for PT, OT and Speech
• Sample Billing Logs for PT, OT, Speech
• Medicare Part A Weekly Meeting Template
• PPS MDS COT Algorithm
• Med A Triple Check Worksheet
• Therapy Discharge Notice (3 Day Notice to Nursing)

Reimbursement – Medicare Advantage Managed Care / HMO:

• CMS Memo 7/1/14 Regarding Managed Medicare MDS HIPPS Codes
• CMS Memo 5/23/14 Update on MDS Requirements
• CMS Memo 12/4/14 Update on MDS HIPPS Codes
  • Interpretation of CMS Memo and MDS Implications

Reimbursement- Medicare Part B:

• Physician Fee Schedule
  • CMS Home Page for 2019
  • 2020 (CY2020) Final Rule – Released 11/1/19 (Unpublished Version)
  • 2020 Proposed Rule – Released 7/30/19
  • 2019 Final Rule – Released 11/23/18
  • 2019 Proposed Rule – Released 7.27.18
  • Archived Rules
    • 2018 Final Rule
    • 2018 Proposed Rule   |   CMS Fact Sheet
    • 2017 Final Rule
    • 2017 Proposed Rule Background Info |  Rule  | FR
    • 2016 – Final
    • 2015 – Final
    • 2014 – Final
• Physician Fee Schedule LOOK UP TOOL
• 2018 Therapy Cap (Discontinued 1/1/18)
• Med B Therapy Cap (Discontinued 1/1/18)
• Med B Functional Limitation Reporting / G Codes (Discontinued by CMS 1/1/19)
• Advanced Beneficiary Notice Forms CMS-R-131
  • When to use and not to use
• Statistics and Report Forms
• Proper use of Modifier 59
• ICD-10-CM Code List: LTC Therapy Most Common Codes (New 10/1/15)
• CPT Codes for PT, OT, SLP  *Updated with 2018 Changes
• **New CPT Therapy Evaluation Codes 1/1/17
  • PT and OT Decision Chart for CPT Evaluation Codes by Complexity
  • PT Decision Chart and Documentation Tool – Eval Codes by Complexity
  • OT Decision Chart and Documentation Tool- Eval Codes by Complexity
• Med B Triple Check Worksheet

Clinical Information:

• Documentation:
  • Fact Sheet: Requirements for Med A vs Med B
  • Evaluation Templates (Medicare Compliant)
    • PT  |  OT  |  Communication |  Swallowing
  • Progress Report Templates
    • PT  |  OT  |  Communication |  Swallowing
  • Daily Treatment Encounter Note Templates
    • PT  |  OT  |  Communication |  Swallowing
  • Dysphagia Plan of Care Template
  • Home Evaluation Forms
• G-Codes   (Discontinued by CMS 1/1/19)
• Total Hip Replacement Precaution Sheet
• Objective Tests and Measures
  • Tinetti Test
  • Berg Balance Test
  • Functional Reach Test
  • Single Leg Stance Documentation Flow Sheet
  • Tandem Stance Documentation Flow Sheet
  • Sit to Stand Test Documentation Flow Sheet
  • 4 Square Step Test Documentation Flow Sheet
• Maintenance Therapy Rules
  • Jimmo Fact Sheet

• ICD-10-CM Code List: LTC Therapy Most Common Codes (New 10/1/15)
• CPT Codes for PT, OT, SLP
• **New CPT Therapy Evaluation Codes 1/1/17
  • PT and OT Decision Chart for CPT Evaluation Codes by Complexity
  • PT Decision Chart and Documentation Tool – Eval Codes by Complexity
  • OT Decision Chart and Documentation Tool- Eval Codes by Complexity
• What is Skilled Therapy Fact Sheet
• Skilled Therapy – Action Word Documentation List
• Lab Values: Norms for Geriatric Population

Compliance:

• Practice Act By State: PT, OT, Speech
• State Operations Manual
• Audit Tools for Documentation, Chart Review
• Sample ADR Response Appeal Letter   Sample 1 |  Sample 2
• Fact Sheet: Documentation Requirements for Med A vs Med B
• Contractures vs MDS Section G ROM
• What is Skilled Therapy: Fact Sheet
• APTA/AOTA/ASHA Consensus Statement on Clinical Judgment/Ethics
• CMS Targeted Probe and Educate (TPE) Audits (New August 2017)

Department Management:

• Medicare Part A / Discharge Planning Meeting Template
• Therapy Schedule and Minutes Tracker
• Billing and Tracking Forms:  PT |  OT |  SLP
• Statistics and Report Forms
• Triple Check Meeting Forms Part A   Part B
• Sample ADR Response Appeal Letter   Sample 1 |  Sample 2

State Survey Information:

• Census and Conditions Report – 672
• Facility Matrix – 802
• QIS Survey Resources and Guides
  • List of QIS Survey Forms
    • Resident Interview and Observation
    • Staff Interview
    • ADL Pathway
    • Restraints
    • Rehab and Restorative
    • Range of Motion
    • Positioning
    • Communication
  • Dementia Care Checklist
  • QIS Process Update Brochure (July 2015)
  • Surveyor Desktop References (July 2015)
  • QIS Fact or Fiction (July 2015)
• Complete list of F Tags
• Survey Preparation Tool for Therapy Staff

State Case Mix:

• State Case Mix Map: Medicaid
• CMI Calculator – NYS
• NYS 2017 Case Mix Census Dates and Roster Upload Info
• NYS 2016 Case Mix Census Dates and Roster Upload Info
• NYS 2015 Case Mix Census Dates and Roster Upload Info
• NYS Dementia / BMI Add-0n Regulations – Criteria
  • NYS Public Health Law
• NYS MDS Roster Submission Op Cert Form
• NYS HCS Access Request Form
• Respiratory Therapy MDS Audit Tool

Nursing:

• ADL Score Determination
  • Algorithm
  • Calculation
• Restorative Nursing Information
  • Documentation Template
• Respiratory Therapy MDS Audit Tool
• What is Skilled Nursing: Fact Sheet
• Triple Check Meeting Forms
• PPS MDS COT Algorithm
• RAI State Coordinators List
• Contractures vs MDS Section G ROM
• PPS 100 Day Tracker Sample 1  |  Sample 2
• Laboratory Values: Norms for Geriatric Population
• Nurse Aide Worksheet: Template
• Advanced Beneficiary Notice:
  • CMS-R-131 | Denial Letters (Discontinued 2018) | SNF ABN  10055
  • NOMNC 10123 | DENC 10124 |  NEMB SNF 20014 (DC 2018)
  • Breakdown of Requirements for each form