Effective July 1, the Centers for Medicare & Medicaid Services will begin rejecting claims received for Medicare Part B patients that do not include the new requirement of G-coding. That really means providers need to be ready by June 1.
While CMS tries to figure out how to proceed with the manual medical review process, we continue to track our caps and apply our modifiers. In the meantime, has anyone noticed how our typical Medicare Part B patients have become more medically complex than just a few years ago?
As a long-term care therapy consultant, I work on a lot of claim reviews and denials management with my clients. I've also read a lot of peer-review research articles related to this subject, and have compiled a list of common mistakes that cause denials. Here's my Top 10 list.
Fuaja Singh completed his last marathon in Hong Kong only a few weeks before he turned 102 years old recently. He said he feels it might be time to retire from running marathons, but he plans to continue running as a hobby. You know what that means.
How do you justify the reason for rehab, length of stay and intensity of treatment? You turn to the 3 C's.
Each time I visited a restroom during a routine site visit, I noticed a very pretty toilet-paper flower there. It was made of toilet paper and folded into a flower, including the stem. It was then sitting in an unused toilet paper roll to serve the purpose of the vase. It was such a clever and creative idea, I wanted to know who was behind this craft.
The Quality Assurance and Performance Improvement system from CMS is on our doorsteps. As facilities have been training and educating themselves, the new QIS (Quality Indicator Surveys) are ready to roll. So, while the entire nursing facility department heads gear up for this new survey process, where does this leave therapy?
Every time we send our patients to the hospital for rehab-related tests, exams or services, these services are billed to Medicare Part B, and, therefore, reduce our cap allowances. Any small oversights could have major impacts on our ability to successfully track therapy cap levels. Here's some help.
The Office of the Inspector General's recent report about what it calls $1.5 billion in inappropriate Medicare payments to skilled nursing facilities should be yet another wake-up call to providers.
Well, we didn't completely go off the "fiscal cliff," but we're definitely heading for a downward slope.
It's hard to believe the holidays are already here. As I have frantically baked cookies, mailed holiday cards and waited in long lines for the perfect gift, I couldn't help but people-watch. I've encountered my share of fellow shoppers that should be posted on various websites for their holiday spirit, or lack thereof.
Hospitals have been undergoing more and more restrictions on re-admissions and are now facing financial penalties in some situations. Unfortunately, this has also resulted in more patients not being classified as "admits" or "re-admits," but rather getting coded as "observation" stays.
I recently had the opportunity to speak at the China Healthcare Sourcing Summit in Hangzhou, China. It was a remarkable experience and really helped me gain a wider perspective of healthcare delivery around the world. Access to healthcare, hospitals, doctors, and especially rehabilitation services is a primary concern for the Chinese government.
What a mess — and that's probably an understatement! Medicare Part B decided to roll out its new manual medical review process by dividing providers into three phases. If you are unfortunate to be part of the Phase One group, you have my deepest sympathies.
Are we being replaced by computers? Most likely the answer is no, but ... computers have made our jobs more efficient, right? Right?
Here it comes again! The Oct 1, 2012, federal regulatory changes will not only impact reimbursement but new reporting requirements also will multiply denials for skilled nursing providers across the country.
These types of short-term rehab patients usually produce the highest reimbursement rates. However, if you're a facility that struggles with admissions and census, be aware that the length of stay will be shorter than your average admission.
Therapy services can be a tricky business when working with residents with a history of "behavioral issues."
Yes, it's true: Our seniors are tech-savvy and love their gadgets. But where does this leave us as clinicians and caregivers? Hopefully, not in the dark.
If a patient can achieve his or her highest level of independence, as a rehab clinician, I say let's go for it. To Medicare reviewers, too often they say stop at the prior level of function. So I often challenge the reviewer to explain this terminology.
I love my grandma dearly. She's still going strong, living independently in a ranch-style house. But while her stubbornness may be the reason she lives such full and active lifestyle, it's also a trait that almost cost her big-time when she had a "health scare" a few years ago.
The theory of improving function in China is overshadowed by the focus on comfort, reducing pain, and providing as much rest as possible. From a cultural standpoint, the family dynamics are very different from our American experiences.
A few years ago, my consulting company had the opportunity to work with a facility to implement a bariatric unit within a skilled nursing facility. This would seem an easy task, but the facility ended up in major renovations for a variety of reasons.
Is it worth it? I'm referring to home visits by the therapy team, the patient, and their family. These are the clinical visits with the patient to their home for a "practice run" conducted several days or a week before their official discharge from the facility.
A few years ago, I broke my leg. Ouch! I was stuck in a long-leg cast for 14 weeks. Luckily, no surgery was required. It was around the holidays, so I asked to have my cast done in red and green stripes.
Have you heard? Yes, it's true. We can now provide therapy co-treatment with another discipline WITHOUT splitting our treatment time. But, not so fast ...
Are the therapy caps back? Well, sort of. Here's a quick summary of the current regulations that were recently passed and how they affect you.
Are you properly capturing set-up time? What on Earth am I talking about? I'm talking about utilizing the regulation as outlined in the Resident Assessment Instrument, version MDS 3.0.
The title sounds like an obvious question, but I can guarantee that the majority of therapists have under billed at some point in their career.
As a manager, I used to love to promote point-of-service, or POS. As a therapist, I used to despise POS. How could I have such a love-hate relationship with POS?
As a manager, I used to love to promote point-of-service, or POS. As a therapist, I used to despise POS. How could I have such a love-hate relationship with POS?
It's not much of a surprise that many therapists are excellent at everything in their job — except screening.
Length-of-stay — LOS — is one of those management reports that often leaves administrators and upper management bewildered. If you increase LOS, you essentially increase your census.
It's that time of year again, time to settle down and get refocused on our goals and ... New Year's resolutions that might have already been broken! Have you kept your resolutions? Has your rehab department kept its?
Has the Centers for Medicare & Medicaid Services underestimated us again? I hope so. On Oct. 1, 2011, CMS implemented new regulation changes that added a Change of Therapy, COT OMRA, MDS. I believe it was intended to decrease our rehab RUG utilization (rehab payment categories), and therefore, decrease Medicare spending
It's that time of year again, the when our hospitals and nursing facilities start to fill up with patients suffering from new fractures, falls, pneumonia and other cardio-pulmonary diseases. However, have we ever thought to provide additional therapy services to our residents (and their family members) who plan to go out for the holidays?
Medical necessity has become a common phrase in healthcare terminology, but what exactly does it mean? Unfortunately, this term has become very subjective and is the primary reason we have been denied payment for services.
When the Centers for Medicare & Medicaid Services implemented its latest rounds of new and stricter regulations, the groan was heard throughout nursing homes across the country. But, I have good news: It is possible to keep an efficient schedule and here's how ...
You are not required to offer therapy services on weekends under new MDS 3.0 changes instituted by the Centers for Medicare & Medicaid Services. But you do have to be careful if you don't.
Since MDS 3.0 was initiated in October 2010, facilities throughout the United States have experienced a significant increase in "A" ADL scoring ratios. By becoming aware of your facility's trends, there are many different ways you can improve this predicament, and receive the proper reimbursement for the services you're providing.
Previously, I've explained my position on the new rehab regulation changes to take effect on Saturday (Oct. 1). However, has CMS gone too far this time?
"They don't need rehab, they're too old!" How many times have we heard or even asked this question? Did you know that Regis Philbin turned 80 on August 25? The Dancing with the Stars cast has included Cloris Leachman, age 85, Florence Henderson, age 77, and Buzz Aldrin, age 81. Celebrities are the easiest to spotlight, but many of us have relatives, friends, and neighbors that exceed the norm.
Have you started your COT trending analysis? On Aug. 8, the Centers for Medicare & Medicaid Services released the final ruling and commentary for the new implementation of the MDS changes set to take effect on Oct. 1. Of these many changes, I believe the most significant will be with the Change of Therapy OMRA.
Shelly Mesure, MS, OTR/L, Author, "Rehab Realities" blog, President and owner, A Mesured Solution Inc.
By simply creating more confusion, the Centers for Medicare & Medicaid Services has made it more difficult for providers. In turn, providers are still expected to be ready to provide the best treatment approaches and use strong clinical judgment without government influences.
If the Ultra High is the highest level of allowable treatment we may seek, it's our professional obligation to clinically provide these levels of service to every patient.
