Harmony Healthcare Blog

The False Improvement Standard: Are Your Therapists Treating All Patients Appropriately?

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Thu, Feb 09, 2017


Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency

As a hospital Occupational Therapist recruited into the long term care industry in the early 90s, I had a lot to learn about the rules and regulations of Medicare.  I was blessed to be trained by expert nurses (Jim Long and Pat Hurd) in a company called HillHaven.  I attended their trainings repeatedly in order to hear their information over and over again.  During this time, Rehabilitation Services in a SNF setting was a new concept and it evoked an excitement at the facility level to “change the perception” of the typical nursing home image. The therapy teams gravitated towards the short term patients with discharge plans to home.  These cases fell in the “wheel house” of any clinician as goals were obvious and success was simply measured by a discharge home. However, the long term patients were more difficult to treat given the perception of the rules.

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Topics: Jimmo, Improvement Standard

Jimmo Settlement: Improvement is Not a Requirement

Posted by The Harmony Team on Tue, Dec 06, 2016


Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency

The presence of underlying diseases such as Multiple Sclerosis, Parkinson’s, ALS, and many other degenerative diseases is not an indicator of whether a patient can participate, gain or benefit from skilled therapy interventions in the skilled nursing home setting.  Further documented progress or lack thereof is not a rational for the denial of a skilled claim.  Per the Jimmo Settlement, when the skills, knowledge and judgment of the therapist are indicated for the delivery of skilled therapy modalities or the patient is medically complex (to the extent that the skills of the therapist are indicated), improvement is not a requirement.   

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Topics: Maintenance Therapy, Jimmo, Improvement Standard

Maintenance Therapy: Top 10 Things to Know

Posted by Melissa Fox on Tue, Nov 08, 2016


Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency

During Harmony Healthcare International’s (HHI) LTPAC Interdisciplinary Symposium, harmony16, guest speaker, Ali Bers, Attorney with Center for Medicare Advocacy shared her knowledge and passion for supporting ongoing skilled services to our elder population.  Here are the top ten things you should know about providing Maintenance therapy.

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Topics: Maintenance Therapy, Jimmo

Maintenance Therapy: Goal Setting in the Skilled Nursing Facility

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Tue, Dec 23, 2014

The Jimmo agreement (Jimmo v. Sebelius) settles once and for all that Medicare coverage is available for skilled services to maintain an individual’s condition. Under the maintenance coverage standard articulated in the Jimmo Settlement, the determining issue regarding Medicare coverage is whether the skilled services of a health care professional are needed, not whether the Medicare beneficiary will "improve." Pursuant to Jimmo, medically necessary nursing and therapy services, provided by or under the supervision of skilled personnel, are coverable by Medicare if the services are needed to maintain the individual’s condition, or prevent or slow their decline (To learn more about the Jimmo Settlement, click here).

When considering how to approach setting goals for a patient receiving maintenance therapy delivered by a clinician, analyze the at-risk behavior or decline that would result from a lack of skilled intervention.

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Topics: Medicare, Therapy, Maintenance Therapy, Jimmo

Jimmo v. Sebelius: Updates for Skilled Nursing & Therapy Services

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Tue, Dec 16, 2014

Alice Bers, Esq., an attorney at the Center for Medicare Advocacy, Inc., and co-counsel for the plaintiffs in Jimmo v. Sebelius, a class action challenging Medicare’s improvement standard, provided attendees of the Harmony 2014 SNF Interdisciplinary Symposium with a recap of the litigation, settlement and recent updates.

To summarize, on January 18, 2011, a Federal Class Action lawsuit was filed by the Center for Medicare Advocacy challenging the inappropriately imposed “improvement standard” on Medicare beneficiaries by the fiscal intermediaries.

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Topics: Jimmo, Improvement Standard, medicare benefit policy

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