Jimmo guidance: Document goal before you provide care

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Therapists should document whether or not the prospective goal of care is maintenance.
Therapists should document whether or not the prospective goal of care is maintenance.

Skilled nursing facilities should not claim that therapy was to maintain a patient's condition if documentation reflected only an improvement goal, according to officials with the Centers for Medicare & Medicaid Services.

CMS recently updated the Medicare manual in light of the Jimmo v. Sebelius settlement. This clarified that Medicare covers so-called maintenance therapy for those who need skilled care but whose conditions are not expected to improve.

However, “it would be appropriate to consider the beneficiary's potential for improvement” in the case of services meant to restore function, according to information presented on a recent Medicare Learning Network call. Therefore, providers should document whether the goal is for restoration or maintenance.

If the goal changes, documentation should reflect an updated goal and care plan, CMS officials said.

Problems will arise if a provider determines that restorative goals were not met at the end of therapy, and then decides, “We're going to call it maintenance,” experts on the call said.

For maintenance therapy, documentation must show the care meets the “skilled” definition for Medicare coverage, because of its complexity or the complexity of the patient's conditions, officials said. 


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