Guided notes week 2- skilled maintenance

True or false: Medicare can deny reimbursement for therapy services on the basis that a patient reaches a plateau and would not likely make further progress or measurable improvement. 

false

 

According to the Medicare Benefit Policy Manual, skilled maintenance therapy is covered in which settings? 

home health, outpatient, SNF

In which setting is skilled maintenance therapy NOT covered?

inpatient rehab

True or False: According to CY 2021 PFS Final Ruling, the furnishing of a skilled maintenance plan may be delegated to a PTA as clinically appropriate. 

true

Which payors DO reimburse for skilled maintenance therapy? 

medicare A, B, and many private insurances

Which form of therapy: Goals are written to improve function or an underlying impairment. 

rehabilitative

Which form of therapy: Documentation of services reflects that a patient’s condition or intervention is complex to the point where services must be delivered by a licensed therapist. 

skilled maintenance and/or rehabilitative

Which form of therapy: Documentation shows that the same activities are completed session after session with little to no variation.  

non skilled care

Which form of therapy: Goals are written to maintain or slow the decline of function. 

skilled maintenance

Which form of therapy: Interventions can be safely and effectively performed by the patient themselves or a family member/caregiver without need for therapist oversight/adaptation.  

non skilled

PT works with a patient following rotator cuff repair. They make slow, consistent progress according to allowances of the post-op protocol and meet their goals. What is the most appropriate next step?

discharge

PT works with a person that has Huntington’s disease that was referred after a recent bout of pneumonia and associated functional decline. They made initial improvements back toward their most recent baseline status over the course of 6 weeks but have not made any further progress in the past 3 weeks. They are at high risk for falls and have had 2 falls at home during the episode of care. They have significant choreoathetosis of all extremities making it challenging for the patient and family to complete a balance program at home.  What is the most appropriate next step?

skilled maintenance therapy

PT works with a patient with chronic low back pain. After 6 weeks, they are no longer demonstrating progress and have not been following through with home exercise recommendations despite observed ability to complete the exercises during sessions. What is the most appropriate next step?

discharge

PT works with a person that has had a stroke. After 6 months of therapy, the patient is no longer demonstrating progress in functional abilities. They require consistent contact guard assistance for mobility skills and can ambulate a max distance of 500 feet with a quad cane during sessions over the past month. They can complete a home program for strengthening with verbal cues to remember the tasks and to complete the correct number of repetitions. They live in an assisted living facility with caregivers available. What is the next appropriate step?

skilled maintenance therapy

True or false: It is only important to document the skill required to complete interventions when you are completing a skilled maintenance episode.  

false

What is the necessary type of documentation when documenting a transition from a rehabilitative episode to a skilled maintenance episode of care? 

progress note that clearly demonstrates the need to transition to skilled maintenance, and that the patient no longer has rehab potential but requires skilled therapy to MAINTAIN current abilities

What are the 4 most common errors in documentation that lead to insurance denials of a skilled maintenance claim? 

Goals for maintenance written to improve function, interventions described in a way that suggests they do not require therapist skill-set, fair or poor rehab potential noted, cloning or copying details from one note to the next

What does SBAR stand for? 

S: situation = concise statement of the problem or primary reason for communication 

B: background = pertinent but brief info related to situation 

A: assessment = analysis of problem and consideration of options 

R: recommendation = specific action that is requested