Show:
30 DAY RULES
13th & 19th RULES
RURAL RULES
AUDITING
MANAGING FAS
100
Who must perform the 30 day assessment?
Qualified therapist of that discipline, assistants may not
100
As long as the 30 day requirement is satisfied, are all visits 1-13 billable?
Yes
100
What CBSA code signifies a rural residence, and where is this information found in AMS?
999xx General information tab
100
If 2 therapists are scheduled to perform a visit on the same day, what is the process in regards to scheduling?
The scheduler will schedule the entire episode of visits as "R" visits. Upon attempt to exit schedule, the system will highlight those days with multi-disciplines scheduled and scheduler will have to sequence those visits and enter comments as to whom is required to make the 1st visit.
100
What key activity assists in accurate scheduling?
Twice daily communication between scheduler and clinician via call in and call out
200
When does the 30 day clock begin?
With 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
If a therapy visit is non-billed utilizing reason code #3 (other), does the system calculate that visit toward the cumulative therapy visit count?
No Visits non-billed with reason code #3 are typically related to visits being completed without MD orders and the system doesn't recognize that as a FA visit occuring.
200
When a missed visit, order to change frequency, or addition of other disciplines occurs, what is the process for schedule re-calculation?
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?
Resets with 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
Can Q-Logic be applied to late FAs?
No There are no exceptions when it is allowed to bill for a late FA
300
In order to accurately ensure schedules are current, what time are ALL clinicians expected to transmit by?
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" 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
If a patient appears on the Therapy FA Non-Bill report, what 3 items are needed to perform an audit?
1. Patient's FA Non-Bill report idenfiying the specifics 2. Agent/Patient log for the related episode 3. FA Billing Audit Tool
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?
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
What are 3 functions that can occur in enter/edit?
1. Make a visit non-billable 2. Make a visit billable (qualified) utilizing a Q-Logic code 3. Correct service codes
500
Name 7 reports that must be worked to manage FAs?
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 6. Air Traffic Control Report 7. Billed & Unbilled mismatch reports