Whose story does your therapy documentation tell?

Therapy documentation should tell a story.

Love hurts PAC relationships

When it comes to developing strategic partnerships across the post-acute care spectrum, love can cloud our judgment.

Beware frog holes and 'I don't knows'

Is there anything more thrilling on a winter day than sledding down the neighborhood's steepest hill, across freshly fallen snow, in an inner tube? I think not.

Treat yourself to a person-directed 2018

In case it hasn't registered yet, the cultural shift from provider-directed care to person-directed care has carried over effectively into the updated state survey processes being implemented secondary to the Phase 2 Requirements of Participation.

Standing tall for veterans

Procedural memory is a fascinating mechanism, a construct of long-term memory and is the form of memory which "we learn by doing," including singing, riding a bike — and saluting, for some.

Nana and Paw Paw, lessons in person-centered care

As we all prepare for the upcoming Phase 2 Requirements of Participation with an increased focus on comprehensive person-centered care planning, we could all learn a few things from my in-laws.

Rehab Week 2017: Where's the skill?

Therapists across the nation had reason to celebrate their varied and respected skills last week. It was National Rehab Awareness Week after all. My, how the celebrations went down.

Restraint-free, sounds good to me

Thursday, Aug. 17 was more than just the first day of school for my children. With all five now in school, it was the first day in 10 years during which we did not have a child at home.

Rehab patients are not always as they appear

We often see a phenomenon in rehab patients at initial presentation. Many times they are not as they appear.

RCS-I: Where will your rehab patients fall?

With the shift from volume in RUGs IV to a goal of value and patient characteristics in RCS-I, rehab providers should ask themselves a number of frank questions.

Speaking 'out of turn'

It is up to caregivers to determine what individuals are attempting to express, and how they should adjust care to meet their needs.

RCS-1 CMS Case-Mix Rule

There is a new horse in town and it goes by the name of RCS-1.

When the patient plot thickens

We had a plan. We should have known better.

Mommy, work's all done

It's 10:42 p.m. when I finally pull into the driveway. A six-and-a-half-hour drive home from a site visit. My in-laws' car is not in the driveway. I take a deep breath. This means that my husband is home alone trying his best to manage our five children ... Lord only knows what kind of a scene I am getting ready to walk into.

SNF Therapy Myths: Busted!

There are many myths surrounding rehab services in skilled nursing facilities. They often come from a lack of understanding of skilled care and a need to increase knowledge of Medicare regulations. I'll bet we have all encountered at least some of these.

Is your rehab partner wearing blinders?

Never, ever bet on a horse wearing blinders. Why, you ask? Because, of course, a horse wearing blinders must be irresponsible, uncontrollable and, worst of all, completely unaware of its surroundings. At least as a child who spent my summers at the track, that was my logic. You need another kind of logic to prepare for the workdays ahead.

Naughty or Nice?

If left up to me this holiday season, I vote let them be NAUGHTY.

Paying it forward

'Tis the season to be giving. My cousin shared with me recently that she had her coffee paid for twice in the past week when going through the drive-thru at a Starbucks. I feel that we could all pay it forward in non-monetary ways to our fellow co-workers and residents.

The Melting Pot

You might be thinking this is going to be about the intriguing restaurant chain The Melting Pot. While I do love fondue (especially the cheese and chocolate varieties), I want to look at something crucial to our profession, and not just our palates.

Entitlement or over utilization?

Many of our therapy patients are medically complex and we, unfortunately, are not able to predict the future, as it sometimes seems that regulators want us to do.

Bon appétit for therapy!

Once upon a time, in a faraway land, physical, occupational and speech therapy used to provide group therapy and often co-treat. This was a totally different time and place for the history of rehabilitation.

Long-term care and therapy: It's complicated

There is an option in Facebook to mark your relationship status as, "It's complicated." This is a great way to sum up everything, without getting too personal. Even though posting your relationship status on Facebook is personal. It's also great way to characterize long-term care therapy.

Dementia or just new batteries needed?

Age-related changes are a natural part of everyone's existence. We can all expect to get wrinkles, gray hair, and decreases in our vision and hearing, among many other delightful changes. However, dementia is not one of these age-related changes to be taken as a "given."

Have we lost our connection to what's important?

We sometimes use high-minded phrases to describe our work and our hopes for our patients. But have we lost our connection to important words? Do they still hold meaning they once did, and if so, how strongly?

Do your residents have a 'sexy style'?

I recently read an article entitled, "J.Lo's sense of sexy style." It really made me think about the nursing home resident's role with this type of thinking.

Dehydration: Therapy should help fight it

The elderly are very vulnerable to dehydration and more than just the nursing staff have to be concerned about it. Not keeping an eye on appropriate hydration can cause a variety of serious problems.

The perfect picnic takes planning — please

Happy Independence Day! This is such a pivotal period in everyone's summer plans, and what a great time for weddings, family reunions and/or the perfect simple picnic. That goes for our frail seniors, too. I know I become happy just thinking about how great it feels to experience the fresh air, sunshine and the smell of nature, and they do too — if things go well.

Tai chi: a trend worth pursuing?

I was recently watching one of the news channels and they talked about a study that was conducted that showed that men who performed tai chi exercises lived longer. While I'm not a male, sign me up!

Pay for performance, medical necessity and Jimmo

Why would anyone mention value-based reimbursement, medical necessity and the Jimmo lawsuit in the same sentence? I feel they are all related, but it will be difficult to find the perfect balancing act to maximize the benefits of each topic.

Are standardized assessment tools our future?

With therapy documentation being put under the microscope more than ever, you would be wise to make sure standardized assessment tools are at your fingertips. Unbiased views of data and outcomes information are what you need for care planning and execution.

Palliative possibilities: Therein lies the rub

When a patient is referred to therapy, and they are receiving hospice care, then therapy needs to seek permission from the hospice company to provide any treatment. Hospice is required to reimburse the facility for the therapy services since the treatment also is included in the bundled payment rate from Medicare Part A. And, therein lies the rub.

Ready, set ... Just kidding! (ICD-10 adventures continue)

Is that how everyone is feeling about the ICD-10 delays? Well, that's how I'm feeling. We almost got within the six-month window for implementation. Just when we were all geared up and ready to go, the government pushes the deadlines out again for one more year.

The power of words

"The pen is mightier than the sword" is an age-old adage that implies that the power of communication — in this case, written communication — is more powerful than a physical weapon. Do you adopt this philosophy with your medical records and rehab documentation? You should.

5 reasons for rehab potential

How many clinicians (physical, occupational, and speech therapy) can honestly say that they have achieved full independence with 100% of every patient they have ever worked with? Unfortunately, I definitely cannot make that claim myself. But is that always the intention anyway?

5 rules of the rehab screen

What is the purpose of a rehabilitation screen? Very simply, we attempt to identify long-term residents' needs and possible rehab potential. Somehow, we don't really have an industry standard on what should take place during a screen.

Defining tolerance in therapy

How do you define tolerance? Is tolerance measurable? Is tolerance too subjective? What about activity tolerance? We love to document how patients are improving activity tolerance, but many times that's all we state in our documentation. So what have we said? Very little.

Top 5 ICD-10 changes for 2014

Have you started your countdown clocks yet? It looks like it's definitely happening this year on Oct. 1, 2014. The transitions from ICD-9 to ICD-10 coding will 100% absolutely take effect for the entire healthcare system, including therapy. So what is this big change all about? Per CMS, here are a couple of key facts everyone should be preparing for.

Therapy patients need, and deserve, this simple self-image booster

Have you ever had a day when you looked great but felt depressed? Or you looked your worst but felt great? Perception of self-image is stronger than actual self-image with determining our emotions. Would you be able to survive an entire day, week or month without looking into a mirror?

Personal stories every therapist should know

What's the point of all of our treatment interventions and plans of care if we can't relate to our patients? If you can put a face and personality behind your justification for therapy services, you'll be way ahead of the game.

New career path?

How many of you will agree with me that we never fully turn off the internal therapist mode when we're in public, outside of work hours?

A home-for-the-holidays checklist for therapy patients

Well, it's that time of year already. Hectic schedules, extra weekend shifts and holiday planning. It's also time for rehab to spend some extra time discussing holiday plans with their patients. Whether it's a short family trip home on the holiday or out to eat at a favorite restaurant, added stress and poor safety judgment can lead to a slew of new and bigger problems.

Jimmo and the future of rehab

On Jan. 24 of this year, the Jimmo vs. Sebelius class action lawsuit was settled. This was a significant win for us, the healthcare providers. As we continue to work out the details, I feel now is a good time for a reminder of the ins and outs the lawsuit. No doubt about it, it was a blockbuster decision.


Can anyone guess what the title to this blog is stating? In the current culture of text messaging and abbreviations for everything, it can be a danger zone for medical documentation. Unfortunately, I have not made up this one.

No more Rehab Medium RUG defaults

Well, Oct. 1 has passed, and we're all still hanging in. The biggest changes we saw to rehab were the addition of reporting co-treatment minutes on our billing logs and Section O on the MDS. And, the new question of "how many DISTINCT calendar days" were received between SLP, OT, and PT.

Ready or not: The MDS is changing again!

On Oct. 1, the Centers for Medicare & Medicaid Services will be updating the Minimum Data Set with another round of changes. Most are minor but there will be two changes to the therapy section. Your case-mix utilization and scheduling, will determine the degree of impact of these new changes.

What's on Your PEPPER Report?

Have you received your provider-specific PEPPER report yet? The Program for Evaluating Payment Patterns Electronic Report (PEPPER) were mailed on August 30 and have been slowly arriving at skilled nursing facilities throughout the country.

Are you prepared? 5 questions you need to know the answers to

With all the recent regulatory changes that have come down the line, or are about to, we developed a simple five-question survey that each provider had to ask every therapy employee. If you can develop strong policies and procedures based on these questions, you will have a good offensive game plan in place.

What is therapy? It's not as simple as it might seem

"What is therapy?" sounds like a simple question, but it requires a separate and very complex answer for each discipline.

50 shades of G-coding

Sorry, ladies, I didn't mean to get your hopes up with that title. But does anyone else feel like there is a lot of ambiguity to the new G-Coding system? Well, it's a little too early to tell for sure, but I can already see how the new G-codes will be riddled with red flags in the next few months.

You're probably guilty of too much documentation

Is it time for a diet? Not a food diet, but a documentation diet. I've written previous blogs about documentation quick tips, top 10 reasons for denials, and so on. But, how many of you are guilty of over-documentation? Is that even possible? Well, yes, it is.

How to document for rehabilitation work objectively

As the scrutiny continues to increase on rehabilitation documentation, finding ways to document objectively has become a major focus for just about everyone involved.

The G-codes are here for payment claims — ready or not

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.

Medically Complex Medicare Part B

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?

Reviewing the top 10 errors in rehab documentation

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.

The lessons of Fuaja Singh

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.

The three C's are the key!

How do you justify the reason for rehab, length of stay and intensity of treatment? You turn to the 3 C's.

Another reason why clinicians shouldn't underestimate housekeeping staff

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.

Do you know your P's and Q's of QAPI?

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?

Loopholes to help you track Medicare Part B therapy billing

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.

OIG? OMG! One lump problem

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.

Fiscal molehill for rehab providers

Well, we didn't completely go off the "fiscal cliff," but we're definitely heading for a downward slope.

Home (safety) for the holidays

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.

Beware of hospital observation loopholes

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.

Access to healthcare is NOT just an overseas problem

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.

The Manual Medical Review mess

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 computers overtaking the therapy department?

Are we being replaced by computers? Most likely the answer is no, but ... computers have made our jobs more efficient, right? Right?

With new rules, more payment denials expected

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.

Short-term rehab pros and cons

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.

The resident's 'right to refuse'

Therapy services can be a tricky business when working with residents with a history of "behavioral issues."

Grandma has an iPad, what now?

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.

Medicare reviewers often stop short

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.

Dear, sweet stubborn grandmother!

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.

Eastern vs. Western standards of practice

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.

Big challenges ahead for therapy

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.

Therapy not complete without some 'home' work

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.

Out with the drab: Time to add personality to healthcare equipment

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.

Therapists can co-treat? Why yes, they can!

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 ...

'The therapy caps are back!!!'

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 setting yourself up for success?

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.

Is this billable time?

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.

Point-of-service: Friend or foe?

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?

Point-of-service: Friend or foe?

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?

Effectively screen those residents

It's not much of a surprise that many therapists are excellent at everything in their job — except screening.

Increasing length-of-stay

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.

Does your therapy department have resolve?

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?

How to profit from the new regulation changes

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

Happy holidays: 'tis the season for more rehab work

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 — slippery for some

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.

Here's how you can effectively schedule rehab

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 ...

How to avoid end-of-therapy pitfalls

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.

Rehab and ADLs

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.

Has CMS gone too far?

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?

How old is too old?

"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.

CMS did more than 'just' cut Medicare pay by 11.1%

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.

Having my say: Top rehab pay for all

Shelly Mesure, MS, OTR/L, Author, "Rehab Realities" blog, President and owner, A Mesured Solution Inc.

To group, or not to group

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.

Top therapy reimbursement for everyone: here's how

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.