Harmony Healthcare Blog

Top 5 Things to Know to Prevent Duplication of Therapy Services

Posted by Kris Mastrangelo on Mon, Apr 25, 2016


Edited by Kris Mastrangelo

TherapyServices.jpgMany times, therapy treatments appear to "overlap" in service delivery.  The Occupational Therapist is working on bed mobility, preparing for the patient's discharge to home.  The patient has a higher than normal bed height determined by the home evaluation tool, and the OT is working on techniques for the patient to Independently transfer with a leg lift.  The OT is simulating the at home bed height and room configuration on a real bed located in the OT gym.

The Physical Therapist is also treating the patient for bed mobility. However, the PT is focusing on rolling and supine to sit.  The patient is currently minimal assistance and requires strengthening and technique in order for the patient to function Independently with bed mobility when discharged to home. The PT is working on the actual rolling, lying to sitting and strengthening on a mat in the PT gym.

While these are clearly two different tasks, they can easily be misconstrued as duplication of services.  This misunderstanding starts with the therapy documentation. 

Top 5 Things to Know to Prevent Duplications of Therapy Services

1.) Educate all the therapists:

Duplication of Services is a common focal point for governmental agencies.  If the documentation depicts two different disciplines treating the same goal or treatment area, the claim will be denied.

2.) Define the differences between the disciplines involved:

Functional Mobility:
PT: Patient will ambulate 50 feet with adequate toe clearance 90% of the time requiring only supervision and a rolling walker.
OT: Patient will demonstrate safe maneuvering in small bathroom space during bathing and toileting tasks as evidenced by no verbal cues for safety and no loss of balance.

Transfers:
PT: Patient will demonstrate 4/5 lower extremity strength to transfer from sit to standing to prepare for ambulation.
OT: Patient will complete a toilet transfer from the bed to commode to facilitate independent toileting.

Balance:
PT: Patient will be able to independently ambulate around obstacles in their room without loss of balance.
OT: Patient will independently complete grooming tasks standing at sink without loss of balance.

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3.)  Treatment activities relate back to goals: 

Be sure to state all goals before treating a certain functional deficit or focus area.  If your are treating for feeding issues, there must be a goal for feeding. 

4.) Progress Note Savvy:

The main function of the progress note is depiction of the rationale for skilled therapy services.   Justification of services requires an understanding of the Medicare rules and critical thinking. 

"Patient requires daily skilled Occupational Therapy 5x/week for 3 weeks for ADL Training  to ensure medical safety and promote recovery.  Patient improved from a minimal assistance to CTG for functional toilet transfer W/C = Toilet (Versa frame and Raised Toilet Seat). Patient requires CTG assistance secondary to decrease balance, left neglect and impulsivity.  OT provides constant verbal cues for technique and pacing. Short Term Goal: Supervised toilet transfer W/C = Toilet (Versa frame and Raised Toilet Seat) with occasional verbal cues for technique and pacing." 

5.)  Depict improvement or prevention of decline:

Medicare supports skilled therapy services when there is  reasonable expectation of improvement or prevention of decline: (Same example as #4, bold highlights improvement and expectation of improvement).

"Patient requires daily skilled Occupational Therapy 5x/week for 3 weeks for ADL Training  to ensure medical safety and promote recovery.  Patient improved from a minimal assistance to CTG for functional toilet transfer W/C = Toilet (Versa frame and Raised Toilet Seat). Patient requires CTG assistance secondary to decrease balance, left neglect and impulsivity.  OT provides constant verbal cues for technique and pacing. Short Term Goal: Supervised toilet transfer W/C = Toilet (Versa frame and Raised Toilet Seat) with occasional verbal cues for technique and pacing." 

Ongoing chart reviews, staff education and interdisciplinary meetings all contribute to avoidance of the above predicament.

If you have questions about duplication of therapy services, please contact Harmony Healthcare International by clicking here or calling our office at (800) 530-4413.

 
HARMONY 2016 

Tags: Therapy Documentation, Duplication of Services

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