Identifying Skilled Services Through Records Review

1. Identifying Skilled Services Through Records Review Get picture to start off part 2Get picture to start off part 2

2.  Skilled Therapy services Require medical training Discipline specific expertise Judgment and Assessment Ongoing Evaluation OT/PT Co-pays – x2 with each visit when both discipline involved Business choices vs. most cost effective careOT/PT Co-pays – x2 with each visit when both discipline involved Business choices vs. most cost effective care

3. Evaluation Requirements Name and Diagnosis Mechanism of Injury (MOI) Prior level of Function Functional Limitations Objective Data of Impairments Pain if it is affecting Function Barriers to Healing or Learning Prognosis Goals with a Time Frame Treatment Plan SLP – replace PAIN with Posture ( how does effect swallowing0SLP – replace PAIN with Posture ( how does effect swallowing0

4. Re-evaluation Requirements Updated information Changes in Treatment Plan or Interventions Comment on original EVAL goals HEP Progressions Functional Limitations Remaining especially limitations that can’t be addressed by HEP New Goals established comment on when/if further Physician intervention is needed ROM? Strength-Skilled movement Rechecks are the priority 1x Q.O. 3 weeks vs. TIW) New goals – Did you overshoot or do they improve faster than expected Emphasize related to MDROM? Strength-Skilled movement Rechecks are the priority 1x Q.O. 3 weeks vs. TIW) New goals – Did you overshoot or do they improve faster than expected Emphasize related to MD

5. Progress Notes vs. Re-evaluations Progress notes are short summaries often intended for physicians. May also contain: new goals, discuss changes in interventions, justify skilled care Usually contain some: Impairment data Occasionally will list functional status Re-evals are all-inclusive and help solidify payment. Cover all aspects: Updated function Highlight changes in impairment data Comment on existing goals State new goals and interventions Justify skilled care Rationale for billing for Re-eval CPT codes This is your chance to update was has been established. Update this every time you re-assess. Medicare every 30 days minimum. Discuss importance of CHANGES being documented in POC. You should always be able to provide some type of update. Re-evals are very different than Progress notes to the MD. When is 97002 billedThis is your chance to update was has been established. Update this every time you re-assess. Medicare every 30 days minimum. Discuss importance of CHANGES being documented in POC. You should always be able to provide some type of update. Re-evals are very different than Progress notes to the MD. When is 97002 billed

6. Assessing Goals - Stairs Climb stairs independently. Climb flight of steps reciprocally without knee giving way.

7. Functional Limitation Goals Sit for 20 minutes so client can eat dinner. Negotiate 2 flights of stairs (carrying groceries). Get in/out of bed with pain level 3/10 or less. Demonstrate good single leg balance to put on pants (or climb stairs). Improve right shoulder flexion to 125 deg. to wash hair (and dry with towel). Walk across a parking lot without LOB (150ft). Run 10ft to reach a mis-behaving toddler. Come up with more goals. Give the audience a medical condition and a few impairments and a DC status you would like them to obtain.Come up with more goals. Give the audience a medical condition and a few impairments and a DC status you would like them to obtain.

8. Coverage for Reimbursement 1. Therapy is medically necessary. 2. Skilled therapy is given. 3. Level of complexity of pt’s condition requires skills of a qualified therapist. 4. Medical record contains active written treatment with goals.

9. Coverage for Reimbursement 5. Treatment Plan describes Specific Therapeutic Interventions. 6. Amount, Frequency & Duration of Therapy should be reasonable and necessary for patient’s condition. 7.Therapy is provided either by or under the supervision of physical therapist. Direct supervision of aide direct/general PTA ( check OT and Speech Pathology)Direct supervision of aide direct/general PTA ( check OT and Speech Pathology)

10. Coverage for Reimbursement 8. Therapy must be provided with expectation that the patient's condition will improve in a reasonable amount of time, or must be necessary to establish maintenance program. 9. Therapy will only be covered until a therapist OR a physician concludes patient is not going to improve.

11. Licensure of Physical Therapist Assistants (PTAs)

12. Who is the PTA? “The Physical Therapist Assistant is a technically educated health care provider who assists the physical therapist in the provision of physical therapy.” The Physical Therapist Assistant (PTA) is a graduate of a PTA associate degree program accredited by the Commission on Accreditation in Physical Therapy Education.

13. Physical Therapist Assistant(PTA) 2 yr Associate Degree Program Licensed in 35 states, certified in 7 states, registered in 3 states and no regulation in 7 states.

14. PTA Accredited ProgramsWisconsin Blackhawk Technical College Gateway Technical College Milwaukee Area Technical College Northeast Wisconsin Technical College Western Wisconsin Technical College Total programs graduate approximately 100 graduates each year. Total programs graduate approximately 100 graduates each year.

15. PTA Utilization The PTA may perform selected physical therapy interventions under the direction and supervision of the PT. The PT is responsible for the initial evaluation of the patient and developing the plan of care and goals for the patient. The PT is legally and ethically responsible for the actions of all support personnel.

16. PTA Utilization The PTA may perform: selected physical therapy interventions as delegated by the PT documentation of interventions performed, data collected and patient progress patient and family education to achieve outcomes of the plan of care

17. PTA Utilization PTA Interaction with the PT: report any significant changes in patient status or response to treatment discuss any suggested changes in the plan of care participates in discharge planning as directed by the PT ***Can an “aide” administer care in Medicare choice HMO***Can an “aide” administer care in Medicare choice HMO

18. “Unlicensed personnel”The Role of the PT Aide “… a person other than a PT or PTA who performs patient related tasks consistent with the unlicensed personnel’s education, training and expertise under the direct on-premises supervision of the PT.” Examples: Athletic trainers, PT techs, aides

19. Support Personnel “may not perform tasks which require the decision making or problem solving skills of a PT, including … patient examination, evaluation, diagnosis or determination of therapeutic intervention.”

20. Records Review I Was Exam provided by a licensed PT? Were interventions based on findings of the exam? Did the PT interventions comply with commonly used practice/treatment protocols? Was the frequency and duration are reasonable for diagnosis that is being treated. Interventions billed require a skilled therapist. Was the PT intervention provided with documented progress/attainment of goals?

21. Records Review II Treatment Plan is consistently reviewed and modified. Was documentation consistent with claims? Were palliative modalities limited to 6-8 weeks (normal tissue healing)? Were multiple modalities used? Substantiated? Does intervention “fade” or plan to fade? Was the PT intervention provided with documented progress/attainment of goals? Are records authenticated? Evidence of PTA supervision?

22. Contact Information WPTA Karen Oshman, Executive Director 608-221-9191 wpta@wpta.org Lynn Steffes,PT WPTA, Reimbursement Specialist stefbiz@wi.rr.com