In the long term care setting, therapy departments are required to balance both Medicare Part A and Medicare Part B patients. Though it may seem like you should just treat all the patients whenever they need it (and in theory you probably should), staffing patterns don’t always allow that to happen. As the Part A caseload increases, the ability to treat the Part B folks diminishes. Unfortunately, we therapists are always good at increasing the Part B caseload when the Part A is slow.
Intermediaries are reviewing medical records in order to recuperate Medicare Part A and Medicare Part B dollars with more force than ever. Recently, we have found more and more audits of patients who fall into the Rehab Ultra High category. This means the therapy documentation of skilled care is under just as much scrutiny as the nursing documentation. How can you know if your documentation will stand up under audit? In steps have you taken to educate your team on Medicare documentation guidelines?
Once upon a time in a therapy department far, far away we all had the flexibility to perform home evaluations to ensure our patients were being discharged to the safest environment possible. With constraints on minute management and demands for increased RUG levels, many departments feel that they cannot spend the time sending therapists out to perform this valuable service. Rates of recidivism are as high as 30% for skilled nursing home patients going home after short term rehab, and as therapists we have all seen the repeat patients that support this figure. Have we sacrificed a key part of discharge planning in our efforts to maximize reimbursement? Are our patients suffering by not participating in home evaluations? How can we marry the ideas of optimizing RUG utilization and ensuring safe discharges home?