Billable Guidelines
When can family Education can be counted as billable?
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
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
F 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
What does ISNP stand for?
Institutional Special Needs Plans
Can a group be billed for part of the patient's treatment?
Yes
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
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.
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
Who is eligible for an ISNP plan?
People who live a SNF for greater than 90 days
When documenting your time, should minutes be rounded?
No- record the exact time to the minute spent with the patient.
What 4 components should be included in daily documentation for a group treatment
1. Type of group provided
2. Benefits of the group as it related to that specific patient's goals
3. Skill provided by the clinician to the patient during the group.
4. Patient's outcome or performance as related to the group treatment
What is the definition of concurrent treatment?
1 therapist or assistant providing treatment to 2 patients at the same time. Each patient is completing a different activity. Each patient’s activity should be focused on their own plans of care.
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
What type of plan is an ISNP?
Medicare Advantage Plan
CMS monitors the plan's marketing/enrollment practices and long-term care facility contracts to confirm that there is no discriminatory impact.
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.
For a Medicare Part A PDPM payer patient, how much concurrent can be billed?
25% group and concurrent combined for the entire episode of care
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
How does reimbursement work for a ISNP patient?
How is therapy reimbursed for Medicare Part A, Managed Care Part A, Medicare Part B, and Managed Care Part B?
Medicare Part A- % of the Case Mix Group
(i.e. TK SA)
Managed Care Part A- Per Minute
Medicare Part B- % of the Fee Schedule
Managed Care Part B= % of the Fee Schedule
What are the benefits of group?
Socialization for the patient, demo learning from a peer, discussion between patients, encouragement from peers, and many more!
When co-treatment, what should be included in the daily note?
The daily note should include the disciplines that co-treated, the focus of the discipline related to a goal.
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
Is an ISNP plan a managed care plan?
Yes- it is managed just like a Humana, but within the center.