Harmony Healthcare Blog

Therapy Co-Treatment Scenarios and Documentation

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Thu, Jun 16, 2016

This week’s Harmony Healthcare International (HHI) compliance reviews spurred discussion surrounding therapy documentation and the clinical indicators surrounding co-treatments as a therapy delivery method.  When two therapists of different disciplines are involved in a combined treatment session, documentation must illustrate the necessity of both disciplines.  This is best conveyed by describing discipline specific tasks addressed during the treatment session.  

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Topics: Therapy Documentation, Occupational Therapy, Physical Therapy, therapy co-treatment

Top 5 Things to Know to Prevent Duplication of Therapy Services

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Mon, Apr 25, 2016

Many 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. 

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Topics: Therapy Documentation, Duplication of Services

Putting 2 & 2 Together: Aligning Therapy & Documentation in the SNF

Posted by The Harmony Team on Tue, Dec 01, 2015

For years, I’ve been hearing dedicated SNF Owners and Operators around the country say things like “The business is getting harder and harder,” or “I’ve never seen things quite like this.” Well, that sure is right. None of us have seen things quite like this.

Many around the country are energized and excited about new initiatives to improve quality and efficiency, return more patients safely to the community, and implement new and exciting treatments to medically complex patients in the SNF setting. Yet, according to the FY 2016 OIG Work plan, the OIG is ready to hammer down on the delivery of SNF therapy in the upcoming year. I understand that the information derived from the PEPPER report shows a startling increase in high intensity therapy in the past 3 years, up almost 9 percent. Don’t we need to consider the fact that SNFs are taking a more medically complex patient population than ever before? Aren’t shorter acute care stays also a factor in the need for more therapy for improved outcomes?

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Topics: Therapy Documentation, Documentation, External Audit

Avoiding Denials: Speech Therapy Documentation in the SNF

Posted by The Harmony Team on Thu, Jul 30, 2015

First, as with any therapy provided in the skilled nursing facility, there must be a significant decline or observation of improvement in performance with a skill once assessed as stable.  For dysphagia concerns, ensure the prior level details the patient’s previous diet as well as the ability to perform other functional tasks, such as clear his or her throat and swallow pills.  For cognitive-linguistic therapy, it is beneficial to provide anecdotal evidence of cognitive function.  For example, if the patient was able to safely navigate to a group activity every week or was independent with his or her pills and financials this would indicate a higher cognitive level.

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Topics: Therapy Documentation, Speech Therapy

Using Standardized Testing to Improve Therapy Documentation

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Fri, Jul 25, 2014

With the spiraling cost of health care in the United States, it is critical to demonstrate the effectiveness and efficiency of therapy treatment.  As payers, health care systems and the public question the efficacy and cost effectiveness of rehabilitation, objective documentation is becoming more important.  Therapists must have a more scientific basis for their practice.  Evidence based treatment is indeed best practice.  Referrals are increasingly based on objective, value-based criteria including metric-driven rehabilitation performance, rates of successful home discharges, re-hospitalization rates and patient experience ratings. 

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Topics: Therapy Documentation, G-Codes

Therapy Screening Techniques: The Critical Role of the Nurse

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Wed, May 14, 2014

While there is a great deal of focus on the management of post-acute patients in the SNF population, many of whom will return to the community, management of long term care patients is equally essential to the provision of services along the continuum of care. According to CMS regulations, long term care patients have a right to function at their highest practicable level, including the delivery of services to slow the progression of decline, as long as these services meet the definition of skilled criteria. In order for these services to be skilled, they must be considered reasonable and necessary and require the skills, knowledge, and judgment of a licensed qualified professional based on their inherent complexity. 

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Topics: Therapy Documentation, Skilled Therapy, Skilled Nursing Documentation, Care Planning

Skilled Therapy Documentation The Importance of Weekly Progress Notes

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Fri, Mar 28, 2014

Increased efforts to audit Medicare records by Medicare Administrative Contractors (MACs), as well as other subcontractors of CMS, should make all providers very conscientious regarding skilled documentation that without question supports the need for daily skilled care.  

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Topics: Therapy Documentation, Documentation, Skilled Therapy

New Final Rule FY 2012 Therapy Documentation Requirements

Posted by The Harmony Team on Wed, Nov 16, 2011

In the Final Rule FY2012, CMS provided clarification on therapy documentation and expectations in regards to changes in therapy treatment plans.  Harmony recommends facilities are vigilant when documenting on patients that have a change in intensity resulting in increased reimbursement for the facility.  Changes to the mode and/or intensity of therapy must be justified by the changes in the beneficiary's underlying health condition.  In order to demonstrate that such changes are medically necessary, the provider should clearly describe in the plan of care the reasons for deviating from the original plan.  The following statements are examples of documentation that would assist in justifying an increase in therapy intensity:

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Topics: Therapy Documentation, Final Rule, CMS

Therapy Notes to prevent Medicare Denials

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Wed, Jun 02, 2010

The Art of Writing Supportive Therapy Notes to prevent Medicare Denials

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Topics: Therapy Documentation, Compliance

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