Harmony Healthcare Blog

Question of the Week: Short Stay Assessments

Posted by The Harmony Team on Tue, May 23, 2017


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

Question:  Does the therapist need to treat the day of discharge in order to qualify for the short stay? 

Answer:  No, the therapist does not need to treat the day of discharge.  Points to know: 

  • Therapy is "ongoing", meaning the treatment sessions would have continued if the patient was not discharged. 
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Topics: Therapy, MDS Short Stay

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

Keep Dementia Training Front of Mind

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Fri, Jun 13, 2014

Keep Dementia Training Front of Mind:  Harmony often discusses clinical review of individual patient interventions with the rehabilitation and nursing team regarding identification, assessment, and management of patients with advanced dementia.  While treatment of low functioning, demented, or long term patients is challenging, Harmony believes that with increased training regarding targeted strategies, this particular group of residents will benefit greatly from skilled interventions. There are three levels of Rehabilitation that meets skilled criteria in the SNF setting.

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Topics: SNF, Therapy, Nursing, Dementia, Skilled Nursing, Skilled Therapy, Rehabilitation, Alzheimer's, patient intervention

Therapy Departments "The Business within the Business"

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Wed, Aug 14, 2013

“Remember, it’s not the questions you ask, but the questions you fail to ask, that shape your destiny.”    Anthony Robbins

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Topics: Therapy

Improve the Accuracy in Coding of Section G; ADL Functional Status

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Wed, Jul 31, 2013

One of the most frequently asked questions during our facility site visits is about how to improve the accuracy in coding of Section G; ADL Functional Status.  The answer is always education, education, education!  Staff turnover and "urban myths" about coding are two barriers that make frequent education a must.  

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Topics: Legislation, Documentation, Medicare, Therapy, CMS, Skilled Nursing

Skilled Therapy Documentation/Standardized Testing

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Sat, Jul 20, 2013

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, Medicare Part B, CMS, G-Codes, ARD

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

Important! Timely Physician Certifications & Re-Certifications

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Tue, Jul 09, 2013

Chart audits revealed an opportunity to obtain timely physician certifications and re-certifications.  The skilled qualifiers must also be identified for the re-certifications versus signed blank.  On medical review, the claim may be denied if this technical criteria is not met. Medicare beneficiaries receiving daily skilled nursing services are of priority as the physician certifies the therapy plan of care for patients on skilled rehabilitation services. Certification for all beneficiaries is essential.

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Topics: Therapy, Compliance

5 Tips to Improve Therapy Documentation

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Fri, Jun 21, 2013

In light of the recent surge of medical record reviews by the federal government, therapists and providers need to sharpen their skills on ensuring that the therapy documentation justifies the services rendered.  The following quick tips should aide in this quest.

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Topics: Documentation, Therapy

Pain Management Intervention

Posted by The Harmony Team on Wed, Oct 17, 2012

Pain management should be an interdisciplinary approach.  For example, nursing can look at PRN versus scheduled medications and what time those medications are administered.  Both therapy and nursing can look at the provision of hot packs, ice packs, therapeutic exercise, range of motion, and positioning techniques.  Your activities department is a hidden resource.  They can help the patient with visualization, relaxation techniques and provide the patient with activities to help distract them from their pain.  Whatever intervention you put in place, you want to make sure it is care planned appropriately and reviewed regularly.  That way you know you have the best intervention in place to help manage your patient’s pain.

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Topics: Therapy, Pain Management, Medicare Minute

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