Applied Healthcare Communication Flashcards
Why focus on applied communication
Writing - one of the most neglected skills, yet most important to productivity
Why focus on applied communication - MMA stands for
Medicare Prescription Drug, Improvement and Modernization Act of 2003
Why focus on applied communication - MMA goals
Identify and recoup underpayments and overpayments made to providers
Actively and aggressively seek out instances of fraud
Why focus on applied communication - MMA - in 2007 RACs found $371 million of improper Medicare payments - most of these related to
Lack of medical necessity and incorrect coding
Documentation for Medicare, Non Medicare and Home Care Services - Medicare certification
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
Documentation for Medicare, Non Medicare and Home Care Services - Medicare progress reports
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
Documentation for Medicare, Non Medicare and Home Care Services - Medicare recertification
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
Documentation for Medicare, Non Medicare and Home Care Services - Documentation requirements
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
Documentation for Medicare, Non Medicare and Home Care Services - Functional limitation reporting
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
Documentation for Medicare, Non Medicare and Home Care Services - Functional limitation reporting - The therapist should include
documentation as to how the functional limitation and severity were determined
Functional impairments must be consistent with treatment goals
Documentation for Medicare, Non Medicare and Home Care Services - Functional limitation reporting - Modifiers
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
Documentation for Medicare, Non Medicare and Home Care Services - Functional limitation reporting - G codes?
PTs usually use Mobility - walking and moving around
OR Changing and maintaining body position
Documentation for Medicare, Non Medicare and Home Care Services - Concerns with Medicare - what needs to be justified
Medical necessity Skill of therapy Length of stay In/Out times SOAP notes Functional goals
Documentation for Medicare, Non Medicare and Home Care Services - Concerns with Medicare - what needs to be justified - medical necessity
Are you able to justify the medical necessity and your skilled intervention
Documentation for Medicare, Non Medicare and Home Care Services - Concerns with Medicare - what needs to be justified - Skill of therapist
Every treatment session should be documented why the skill of PT is needed
Documentation for Medicare, Non Medicare and Home Care Services - Concerns with Medicare - what needs to be justified - Length of stay
If you increase or decrease the visits you need to document clearly why
Documentation for Medicare, Non Medicare and Home Care Services - Concerns with Medicare - what needs to be justified - In/Out times
All times must be documented along with duration of minutes for each code
Documentation for Medicare, Non Medicare and Home Care Services - Concerns with Medicare - what needs to be justified - SOAP notes
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
Documentation for Medicare, Non Medicare and Home Care Services - Concerns with Medicare - what needs to be justified - Functional goals
Remember to keep your goals functional, based on pt required ADL and IADL requirements
Documentation for Medicare, Non Medicare and Home Care Services - Setting specific considerations in documentation - Acute care hospitals
Document hand offs - transfer care of pt for the weekend for example - needs to be documented in the note
Documentation for Medicare, Non Medicare and Home Care Services - Setting specific considerations in documentation - Health, wellness, and fitness
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
Skilled Nursing Facility and Non Medicare - SNF criteria
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
Skilled Nursing Facility and Non Medicare - A safety problem exists when
A patient wihtout skilled assistance cannot handle him/herself in a manner that is physically safe
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
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
Skilled Nursing Facility and Non Medicare - Safety dependence - Documentation of safety concern
Use objective tests and measures
Note number of falls reported prior to hospitalization and during
Document impairments and mobility dependence
Skilled Nursing Facility and Non Medicare - Mobility dependence
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
Skilled Nursing Facility and Non Medicare - Non medicare - Private insurance companies
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
Home Care - Medicare home health is reimbursed on
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
Home care - Criteria - pt is homebound if
- 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!!!
Home care - documentation forms
OASIS Transfer to inpt facility Resumption of care OASIS Recertification OASIS Discharge OASIS
Home care - documentation forms - OASIS
Tool to complete at the beginning of an episode
Home care - documentation forms - Transfer to inpt facility
Completed when a pt is admitted to SNF or admitted to the hospital for more than 24 hours
Home care - documentation forms - Resumption of care OASIS
Completed if patient goes to the hospital and returns home during 60 day period
Home care - documentation forms - Recertification OASIS
Completed between days 56 and 60 of the episode of care
Home care - documentation forms - Discharge OASIS
Completed when patent meets all of their goals or they expire
Home care - documentation forms - completion of the OASIS
A nurse or physical therapist is responsible for completion of it
Justification letters - required for
specialized equipment or services
Medical necessity is often required for expensive equipment such as a powered wheelchair, customized wheelchair, specialized equipment and devices
Justification letters - written for
Additional PT visits to insurance companies or for reimbursement purposes
Justification letter - components of a letter
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
