Harmony Healthcare Blog

Maintenance Therapy (Medicare Part B): Can it be Rendered by a PT Assistant?

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Tue, Nov 07, 2017


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

A Skilled Nursing Facility underwent an audit which depicted Medicare Part B Maintenance Therapy rendered by a PT Assistant.  The auditors recommended  a governmental pay back for all the revenue billed for these services becausethe services must be rendered by a Registered Physical Therapist.

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Topics: Maintenance Therapy

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

Making Sense of New CMS Guidelines for Maintenance Therapy

Posted by The Harmony Team on Wed, Jul 17, 2013

The Jimmo v. Sebelius lawsuit was brought on behalf of a nationwide class of Medicare beneficiaries by six individual Medicare beneficiaries and seven national organizations representing people with chronic conditions. The Jimmo v. Sebelius case challenged Medicare's use of an "Improvement Standard" to make coverage determinations. On January 24, 2013, a settlement was approved by the federal district court of Vermont expanding Medicare Part A and Part B coverage to include the rendering of skilled nursing and therapy services necessary to maintain a person's condition.

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Topics: Legislation, Documentation, Therapy, CMS, Maintenance Therapy

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