Ask the payment expert ... about the observation stay loophole

I am seeking info about rehab services in a swing bed setting. I know services need to be daily and require a skilled caregiver. Can OT or SLP alone meet the criteria without PT or nursing, if the need is daily?

The easy answer is yes. We see no reason why providing rehab in a swing bed for OT/ST only would be problematic from a regulatory perspective.

All three disciplines can stand on their own for daily skilled rehab. The Medicare Benefit Policy Manual describes what are skilled services, documentation requirements and other guidelines: “If the inherent complexity of a service prescribed for a patient is such that it can be performed safely and/or effectively only by or under the general supervision of skilled nursing or skilled rehabilitation personnel, the service is a skilled service.”

In addition, the manual discusses the requirements for documentation to support a skilled care determination. A swing bed facility needs to follow the same regulations as a SNF. A critical access facility is exempt from payment, but it still must follow the same rules as SNFs. The regulations also talk about what determines what is skilled. So, a few words of caution …

Make sure your documentation can stand up to scrutiny and meets skilled criteria. You should be cautious that the patient meets the skilled requirement of needing care that can only be provided in an inpatient setting.

Often, medical review considers that they do not need inpatient care even if they need daily care, which could be provided in a lesser environment. Therapy services without PT can target you for more medical review.

Speech therapy standing alone is rare and occurs usually in the case of severe dysphagia with PEG feedings and/or a combination of dysphagia and severe aphasia or cognitive deficit.

Please send your payment-related questions to Patricia Boyer at [email protected]