Applied Healthcare Communication

Question 1

Why focus on applied communication

Answer 1

Writing - one of the most neglected skills, yet most important to productivity

Question 2

Why focus on applied communication - MMA stands for

Answer 2

Medicare Prescription Drug, Improvement and Modernization Act of 2003

Question 3

Why focus on applied communication - MMA goals

Answer 3

Identify and recoup underpayments and overpayments made to providers

Actively and aggressively seek out instances of fraud

Question 4

Why focus on applied communication - MMA - in 2007 RACs found $371 million of improper Medicare payments - most of these related to

Answer 4

Lack of medical necessity and incorrect coding

Question 5

Documentation for Medicare, Non Medicare and Home Care Services - Medicare certification

Answer 5

Certification of POC requires the physician/non physician provider approval of the plan
Required within 30 treatment days after initial visit
An initial certification may be written for period of up to 90 days

Question 6

Documentation for Medicare, Non Medicare and Home Care Services - Medicare progress reports

Answer 6

Med B - at least once every 10 tx days or once during interval of 30 calendar days (whichever happens first)
Med A - often PR are weekly

Question 7

Documentation for Medicare, Non Medicare and Home Care Services - Medicare recertification

Answer 7

Requires the physician/non physician provider approval of plan
Recert date is up to 90 days - the initial POC must be recertified when the initial POC is extended or at least once every 90 days - whichever comes first

Question 8

Documentation for Medicare, Non Medicare and Home Care Services - Documentation requirements

Answer 8

Evaluation and certified POC
Certification - physician approval 30 days after initial tx
PR - required every 30 days or every 10th tx
Recert - every 90 days or for significant change in status or POC
Tx encounter note/daily notes
Discharge note

Question 9

Documentation for Medicare, Non Medicare and Home Care Services - Functional limitation reporting

Answer 9

All outpatient under Med B must supply this on claim form
G codes and modifiers are included on claim at initial visit, min of every 10th visit AND at discharge
Modifiers indicate severity/complexity of the functional limitation

Question 10

Documentation for Medicare, Non Medicare and Home Care Services - Functional limitation reporting - The therapist should include

Answer 10

documentation as to how the functional limitation and severity were determined
Functional impairments must be consistent with treatment goals

Question 11

Documentation for Medicare, Non Medicare and Home Care Services - Functional limitation reporting - Modifiers

Answer 11

CH = 0 percent impaired, limited or restricted
CJ = at leas 20 but less than 40
CK = at least 40 but less than 60
CN = 100 percent impaired, limited or restricted

Question 12

Documentation for Medicare, Non Medicare and Home Care Services - Functional limitation reporting - G codes?

Answer 12

PTs usually use Mobility - walking and moving around

OR Changing and maintaining body position

Question 13

Documentation for Medicare, Non Medicare and Home Care Services - Concerns with Medicare - what needs to be justified

Answer 13

Medical necessity 
Skill of therapy
Length of stay
In/Out times
SOAP notes
Functional goals

Question 14

Documentation for Medicare, Non Medicare and Home Care Services - Concerns with Medicare - what needs to be justified - medical necessity

Answer 14

Are you able to justify the medical necessity and your skilled intervention

Question 15

Documentation for Medicare, Non Medicare and Home Care Services - Concerns with Medicare - what needs to be justified - Skill of therapist

Answer 15

Every treatment session should be documented why the skill of PT is needed

Question 16

Documentation for Medicare, Non Medicare and Home Care Services - Concerns with Medicare - what needs to be justified - Length of stay

Answer 16

If you increase or decrease the visits you need to document clearly why

Question 17

Documentation for Medicare, Non Medicare and Home Care Services - Concerns with Medicare - what needs to be justified - In/Out times

Answer 17

All times must be documented along with duration of minutes for each code

Question 18

Documentation for Medicare, Non Medicare and Home Care Services - Concerns with Medicare - what needs to be justified - SOAP notes

Answer 18

Need to be specific about each treatment and the outcome of the treatment - it is NOT acceptable to state “see flow sheet” without other comments

Question 19

Documentation for Medicare, Non Medicare and Home Care Services - Concerns with Medicare - what needs to be justified - Functional goals

Answer 19

Remember to keep your goals functional, based on pt required ADL and IADL requirements

Question 20

Documentation for Medicare, Non Medicare and Home Care Services - Setting specific considerations in documentation - Acute care hospitals

Answer 20

Document hand offs - transfer care of pt for the weekend for example - needs to be documented in the note

Question 21

Documentation for Medicare, Non Medicare and Home Care Services - Setting specific considerations in documentation - Health, wellness, and fitness

Answer 21

Could be individual or group therapy
Make sure the level of detail is based on complexity of the client - so if more complex patient, the documentation should have a lot more to it

Question 22

Skilled Nursing Facility and Non Medicare - SNF criteria

Answer 22

1 Performed by or under supervision of licensed PT and has a skilled need
2 At least a 3 night hospitalization stay
3 Pts medical condition is a valid factor in consideration for skilled need, but diagnosis and prognosis should not be the sole factor
4 The pts total condition and complexity of the condition requires skilled management services even though some services can be unskilled

Question 23

Skilled Nursing Facility and Non Medicare - A safety problem exists when

Answer 23

A patient wihtout skilled assistance cannot handle him/herself in a manner that is physically safe

Question 24

Skilled Nursing Facility and Non Medicare - Safety dependence - Some ex of safety dependence that require skilled therapy intervention to protect the patient from further complications include

Answer 24

Probability of falling
Impaired balance and head control
Swallowing difficulties
Lack of awareness of safety hazards
Severe pain
Loss of skin sensation
Progressive joint contracture infection
Environmental barriers or hazards

Question 25

Skilled Nursing Facility and Non Medicare - Safety dependence - Documentation of safety concern

Answer 25

Use objective tests and measures
Note number of falls reported prior to hospitalization and during
Document impairments and mobility dependence

Question 26

Skilled Nursing Facility and Non Medicare - Mobility dependence

Answer 26

The individual is dependent upon another person for skilled therapy assistance or supervision in such areas as transfer, gait training, stair climbing, and wheel chair maneuvering activities due to:

• Dec strength
• Marked mm spasticity
• Contractures
• Impaired attention span
• Perceptual motor loss
• Lack of awareness of sensory cues
• Orthotic need
• Need for ambulatory or mobility device
• Gait abnormality

Question 27

Skilled Nursing Facility and Non Medicare - Non medicare - Private insurance companies

Answer 27

Tend to follow the guidelines of medicare
Documentation requirements tend to follow medicare guidelines
Use a SOAP note format and flow sheets - Move to International Classification of Functioning, Disability, and Health (ICF) model with documentation

Question 28

Home Care - Medicare home health is reimbursed on

Answer 28

A prospective payment system (PPS)
Payment is a specified amount of money determined by several factors with the major factor being:
- The home health resource group (HHRG) based on data from the OASIS (outcome and assessment and information set evaluation tool) per 60 day episode

Question 29

Home care - Criteria - pt is homebound if

Answer 29

• A skilled need is required (PT, RN)
• Able to go to doctor appts
• Able to attend church
• Able to visit barber/stylist
• Able to attend grand events/celebrations
• Cannot receive OPT PT
• Cannot go shopping, dining out, visiting, shows, concerts, fairs etc

Transportation issues alone are not a reason for need of home therapy!!!

Question 30

Home care - documentation forms

Answer 30

OASIS
Transfer to inpt facility
Resumption of care OASIS
Recertification OASIS
Discharge OASIS

Question 31

Home care - documentation forms - OASIS

Answer 31

Tool to complete at the beginning of an episode

Question 32

Home care - documentation forms - Transfer to inpt facility

Answer 32

Completed when a pt is admitted to SNF or admitted to the hospital for more than 24 hours

Question 33

Home care - documentation forms - Resumption of care OASIS

Answer 33

Completed if patient goes to the hospital and returns home during 60 day period

Question 34

Home care - documentation forms - Recertification OASIS

Answer 34

Completed between days 56 and 60 of the episode of care

Question 35

Home care - documentation forms - Discharge OASIS

Answer 35

Completed when patent meets all of their goals or they expire

Question 36

Home care - documentation forms - completion of the OASIS

Answer 36

A nurse or physical therapist is responsible for completion of it

Question 37

Justification letters - required for

Answer 37

specialized equipment or services
Medical necessity is often required for expensive equipment such as a powered wheelchair, customized wheelchair, specialized equipment and devices

Question 38

Justification letters - written for

Answer 38

Additional PT visits to insurance companies or for reimbursement purposes

Question 39

Justification letter - components of a letter

Answer 39

Detailed information about pt condition 
Specific benefits pt will receive from equip
What are special components or additions
Medical necessity 
Readability
Correct language 
Avoid jargon or ambiguous terminology
Support with EBP and research when applicable