Students/Techs
Can a therapy aid/tech provide skilled services?
Family Education can be counted as billable time when....?
The patient is present for the education.
What is the definition of Group Therapy for Med A or Managed A payers?
2-6 patients performing the same or similar activity under supervision of 1 therapist
IF Mrs. T has Medicare Part A and Mrs. W is private pay for therapy, and Mrs. T and Mrs. W are treated for 30 minutes at the same time, but performing different types of therapy, what mode should be billed?
CONCURRENT THERAPY for 30 min for Mrs. T and Mrs. W
When documenting a Managed Care Part A group treatment, what items are important to include in the TENs notes?
Number of people in the group
Type of group
Individual cues for that participant in the group
Response to the group
If a student is treating a Medicare Part A patient, what type of supervision is required of the clinical instructor?
Line of sight supervision is not required....Within individual facilities, supervising therapists/assistants must make the determination as to whether or not a student is ready to treat patients without line of sight supervision. Additionally all state and professional practice guidelines for student supervision must be followed.
Can concurrent be billed for Part B patients?
No-
Treatment of 2 residents, by the same therapist or student who are NOT completing the same or similar activities, simultaneously
OR
Student is treating 1 patient and supervising therapist is treating another patient
What is the definition of group for Part B patients?
Two or more individuals being treated simultaneously, under the supervision of 1 therapist or student, who may or may not be performing the same activity
IF Dr. D has Medicare Part B and Mrs. L had Medicare Part A, and they both receive 35min. of therapy at the same time but not the same activities, what mode should be billed?
GROUP THERAPY for 30 min. for Dr. D and CONCURRENT THERAPY for 30 min. for Mrs. L
When documenting on a Medicare Part B patient who has participated in a group, within the documentation what type of information should be included?
Number of people in the group
Skilled statements
Response to group treatment
Who can serve as a clinical instructor?
Any clinician with qualifying experience:
All clinical instructor placements must be approved by regional and center leadership.
PTs can have SPT and SPTAs- After 1 year.
OTR can have SOT and SCOTAs- After 1 year
PTA can have SPTAs- After 1 year
COTAs can have SCOTAs- After 1 year
SLPs can have SSLPs-
When documenting your time, should minutes be rounded?
No- record the exact time to the minute spent with the patient.
Can a group be billed for part of the patient's treatment?
Yes
IF Mr. W, Mrs. X, Mrs. Y, and Mr. Z are receiving similar services at the same time for 30 min. Mr. W, and Mrs. X have Medicare Part A, Mrs. Y has Private Insurance, and Mr. Z has Medicare Part B, what mode should be billed for each patient?
GROUP THERAPY for Mr. W and Mrs. X for 30 min, GROUP THERAPY for Mr. Z for 30 min, GROUP THERAPY for Mrs. Y for 30 min.
When documenting a co-treatment, what are important pieces of information to be included in the TENs notes?
Skilled statements specific to your discipline
Why co-treat was need for each discipline to achieve their goals
What discipline did the co-treat occur with
How many centers does Stonerise have currently?
There are 17 centers.
What is the difference between skilled and non-skilled therapy?
Skilled Care
Interventions provided by a qualified therapy clinician involving complex and sophisticated skills that can only be conducted by a licensed therapist or therapy assistant
Non-Skilled Care
Care provided, by a therapist or an assistant, that does not require the skills of a licensed therapy clinician to conduct, i.e. walking a patient vs. gait training, watching someone eat vs. dysphagia treatment
What is the percentage of group that can be billed for Medicare Part A?
25%. There is no cap for Managed A or Part B payers.
IF Mrs. V has Medicare Part A, begins therapy in an individual session. After 13 minutes the therapist begins working with Mr. S., whose therapy is covered by Medicare Part B, while Mrs. V. continues with her skilled intervention and is in line-of-sight of the treating therapist. The therapist provides treatment during the same time period to Mrs. V. and Mr. S. for 24 minutes who are not performing the same or similar activities, at which time Mrs. V.’s therapy session ends. The therapist continues to treat Mr. S. individually for 10 minutes. What mode should be billed for each patient?
INDIVIDUAL THERAPY for 13 min. and concurrent therapy for 24 min. for Mrs. V.
GROUP THERAPY for 24 min. and individual therapy for 10 min. for Mr. S
You are treating 2 Medicare Part A patients who are performing different tasks at the same time. The documentation that should accompany this treatment needs to include what info specifically?
Skilled Therapy Statements
Response to Treatment
What criteria must be met for a student to provide billable services while treating a Medicare Part B patient?
Qualified professional is present and in the room for the entire session.
Student participates in the delivery of services when the qualified practitioner is directing the service- making the skilled judgement and is responsible for the assessment and treatment
Practitioner is not engaged in treating another patient or doing other tasks at the same time
Qualified professional is the person responsible for the services and signs all documentation
What is the definition of co-treatment?
Co-treatment
When two clinicians from different disciplines, treat the same resident simultaneously with differing treatments. Documentation must support the need for both disciplines. Time billed must represent the time each discipline provided skilled care.
What are the benefits of group?
Socialization for the patient, demo learning from a peer, discussion between patients, encouragement from peers, and many more!
IF Mr. A. and Mr. B., whose stays are covered by Medicare Part A, begin working with a physical therapist on two different therapy interventions. After 30 minutes, Mr. A. and Mr. B are joined by Mr. T. and Mr. E., whose stays are also covered by Medicare Part A., and the therapist begins working with all of them on the same therapy goals as part of a group session. After 15 minutes in this group session, Mr. A. becomes ill and is forced to leave the group, while the therapist continues working with the remaining group members for an additional 15 minutes. What mode should be billed for each patient?
GROUP THERAPY for 15 min. and CONCURRENT THERAPY for 30 min. for Mr. A
GROUP THERAPY for 30 min. and CONCURRENT THERAPY for 30 min. for Mr. B
GROUP THERAPY for 30 min. for Mr. T
GROUP THERAPY FOR 30 min. for Mr. E
What is the top 3 reasons for documentation denials?
1. Lack of Skilled Statement
2. Technical Issues- Lack of signatures, untimely signatures, missing orders
3. Lack of Response to Treatment