30 DAY RULES
13th and 19th Rules
RUAL
FA PROGRAMMING UPDATES
MANAGING FAS
100
Who should perform the 30 day assessment?
What is a Qualified therapist.
100
999xx
What is the CBSA code signifies signifies a rural residence.
100
1. “Close to” Scheduling 2. Multiple Visit Sequencing 3. FA Billing Recognition 4. 30-Day Gap in Care 5. Order of Rules Broken 6. Rural Code 7. Scheduling for Assistant versus Qualified Therapist 8. Non-Medicare PPS Issues 9. Orphaned FA’s
What are the Nine New Functional Assessment Programming Updates.
100
What key activity assists in accurate scheduling?
What is Twice daily communication between scheduler and clinician via call in and call out
200
When does the 30 day clock begin?
What is the 1st therapy service of that discipline
200
As long as the 30 day rule and the 13th visit rule is satisfied, are visits 14-19 billable?
Yes
200
Does the permanent rural residence CBSA code require a Q-Logic entry in enter/edit?
No AMS programming is set up to recognize these sets of patients and will automatically allow for early FAs as long as CBSA code corresponds
200
On any day that multiple disciplines are scheduled, the system will require the multiple visits to be numerically sequenced prior to exiting the schedule.
What is MULTIPLE VISIT SEQUENCING
200
When a missed visit, order to change frequency, or addition of other disciplines occurs, what is the process for schedule re-calculation?
What is Scheduler will make needed corrections in scheduling system, go to the list mode, change all future visits after the changes to "R" and exit. This allows the system to recalculate the needed 13, 19, and/or 30 day FA
300
What triggers the 30 day clock to reset?
What is each Therapists successive Functional Assessment
300
Assuming we are in a single discipline case, if the FA visit was completed on visit #12 and an assistant completes visit 13, are we compliant with FA rules? Please explain answer
No In single discipline cases, the qualified therapist must perform the FA visit on actual visit 13 or 19
300
With the permanent rural residence CBSA code, are clinicians required to have validation of qualifying reason documented on the visit note or a communication form?
No AMS programming is set up to recognize these sets of patients and will automatically allow for early FAs as long as CBSA code corresponds and does not require further documentation from clinicians
300
If another therapy is added during the course of treatment you must.....
What is change all future therapy visits back to “R” codes and let the computer determine where the FAs will now need to be scheduled
300
In order to accurately ensure schedules are current, what time are ALL clinicians expected to transmit by?
What is No later than 10am the next business day
400
Will all therapy visits that span greater than 30 days always be reported as non billable on the Therapy Non Bill report (this includes hospital spans or therapy re-entry post previous discipline discharge) ?
No. If an evaluation is completed (PH, ROC or EVA), reasonable gaps in care (prior discharge from service, patient went into hospital, etc) greater than 30 days will NOT report the resuming FA as non billable on the Therapy Non Bill report. If a non evaluation FA form is used for the resuming visit, the initial visit WILL report as non billable.
400
Assuming we are in a muti-discipline case, does each discipline have to complete their FA visit on actual visit 13 and/or 19? Please explain
No CMS guidelines language state "close to"or "closet to" visit allows for FAs to be performed prior to the actual 13th and/or 19th visit
400
Since the patient lives in a rural CBSA code, is it okay for the FA visit to occur after visit 13 or 19?
No There are currently NO exceptions that allow a FA visit to occur late
400
FA BILLING RECOGNITION: After the new release the FA non-bill system will recognize ______ to determine if an FA was actually performed for any transmitted visit.
What is FA note/chunk.
400
When patients show on the Therapy FA Non Bill report, items noted on that report are always correct and should immediately be changed to non bill in enter/edit?
What is No All patients identified on this report need to have a complete FA audit done utilizing the FA billing audit tool as there are instance that Q-Logic may be utilized that will over-ride what report finds. Audits are then maintained with daily billing.
500
Assuming we are in a multi-discpline case, if one discipline misses their FA, do all disciplines require non-billed? Please explain reason behind answer
No 30 day FAs are the only billing requirement that is discpline specific, therefore all other disciplines remain billable and are counted in the cumulative count as long as they have satisified their 30 day FA requirement
500
Assuming we are in a muti-discipline case, if FA visits are not completed according to requirements by all therapists for the 13th and 19th collective visits, what must occur related to billing? Please explain rule
Visit(s) will need to be non-billed for all therapy visits until after the discipline(s) that missed FA visit has satisfied the FA ruling
500
With the rural residence CBSA code, what is the earliest a 13th visit can occur? What is the earliest a 19th visit can occur?
For 13-visit can occur after the 10th therapy visit but no later than the 13th For 19-visit can occur after the 16th therapy visit but no later than the 19th ***Any visit prior to the parameters listed will need reviewed and approved by ARD/RRD to utilize Q-Logic***
500
This message will display IF two visit notes were performed by the same discipline on the same day and a Clinical Note Addendum with the FA components has been transmitted in addition to the multiple notes.
What is Alert message for FA clinical note addendum
500
Name 5 reports that must be worked to manage FAs?
What are 1. Weekly Frequency Report 2. Missed Visit & Unscheduled Visit Report 3. POC Visit Transmission Report 4. FA Exception Report 5. Therapy FA Non Bill Report
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