1. Home Health and House Calls

2. FULL RANGE PHYSICAL THERAPY
Mission
To provide quality health and wellness services through promoting and encouraging individual achievement through a healthy lifestyle.
FULL RANGE PHYSICAL THERAPY

3. Home Health Therapy Orientation FULL RANGE PHYSICAL THERAPY
Home Health (Part A) vs Outpatient (Part B)
Therapy Utilization
Therapy Reassessment
Documentation Tips
FULL RANGE PHYSICAL THERAPY

4. FULL RANGE PHYSICAL THERAPY
Medicare
Background:
Medicare is a federal insurance program for people age 65 or over, for the disabled, and for persons with chronic disorders
Part A- automatically available at no cost when a beneficiary has been contributing to Social Security
Part B- (optional) and beneficiary must pay a monthly premium. It covers outpatient services
FULL RANGE PHYSICAL THERAPY

5. Services Covered by Medicare Benefit Type
Part A
Part B
Home Health Services
Skilled Nursing
Physical Therapy
Occupational Therapy
Speech Therapy
Medical Social Worker
Home Health Aide
Outpatient Services
Outpatient PT
Outpatient OT
Outpatient SLP
Wound Center
Observation Stays
FULL RANGE PHYSICAL THERAPY

6. Eligibility Criteria for Services
Part A
Part B
The patient must have a need for skilled care and therapy services must be medically necessary.
NO HOMEBOUND STATUS REQUIRED
The patient must have a skilled need for home care services. The patient must also meet the CMS definition of homebound:
“… there exists a normal inability to leave home would require a considerable and taxing effort.”
FULL RANGE PHYSICAL THERAPY

7. Location for Provision of Services
Part A
Part B
May or may not be in the patient’s home
Note: If renting gym space, this is no longer considered a ‘common area’ – Only Part B clients can be seen here
In the client’s home
In Senior Living, common areas are considered part of the client’s home
Leased space is not considered common space
FULL RANGE PHYSICAL THERAPY

8. Payment Method by Treatment Setting
Part A
Part B
Prospective Payment (PPS)
Payment is based upon the patient’s condition and care needs as determined by OASIS findings
Covered in full by Medicare
Fee for Service Reimbursement (FFS)
Payment is based on the Medicare Physician Fee schedule for each CPT code billed per treatment session
Payment is therefore made after the insurance receives the claim for each date of service
Secondary insurance or 20% responsibility
FULL RANGE PHYSICAL THERAPY

9. FULL RANGE PHYSICAL THERAPY
Intro to Home Health
PPS- Episodic Payor
60 Day Episode
May be recertified for additional 60 day periods
OASIS determines initial need for services
Services should be based on medical necessity
FULL RANGE PHYSICAL THERAPY

10. FULL RANGE PHYSICAL THERAPY
Criteria for Home Care
Medicare Criteria Conditions of Participation (COP)
Client must meet all 4 of the following to receive home care services under Medicare:
Homebound
Skilled care, Medically reasonable & necessary services
Nursing/therapy need must be part time/intermittent (Progress vs Skilled Standard)
Plan of treatment must be authorized by a physician
FULL RANGE PHYSICAL THERAPY

11. What Qualifies a Client as Homebound
Examples of homebound clients
Client needs assist of one person to safely get out of home
Client unable to leave home due to shortness of breath on minimal activity
Unsteady gait with walker and is unable to safely navigate stairs outside of the home
Client confused due to Dementia and requires supervision to safely leave home
FULL RANGE PHYSICAL THERAPY

12. May Homebound Clients Leave the Home?
Yes- If it meets the following criteria
Absences from the home are infrequent or for periods of relatively short duration, or are attributable to the need to receive health care treatment.
Examples of health care treatments:
Outpatient dialysis
Receiving outpatient chemotherapy or radiation therapy.
Physician’s appointment
FULL RANGE PHYSICAL THERAPY

13. Homebound Clients May Leave the Home
Examples of other non medical reasons for a client to leave the home and still be considered homebound:
Religious services
Attendance at a family reunion, funeral, graduation, or other infrequent/unique event, as long as absences are infrequent and do not indicate that the client has the capacity to obtain the health care provided outside rather than inside the home. As long as theses absences are infrequent.
FULL RANGE PHYSICAL THERAPY

14. What is considered skilled care?
Therapy- examples of care that require the skill of a therapist:
Gait or balance training
Exercise instruction or teaching
Communication/speech interventions
ADL training
Progress Standard vs Skilled Standard
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15. Reasonable and Necessary
What might not be considered medically reasonable & necessary?
Continued Nursing and/ or Therapy visits to a client with COPD, who has:
Stable vital signs for the last 2 weeks
No other teaching needs
No changes in strength or mobility
No changes in health status
FULL RANGE PHYSICAL THERAPY

16. Plan of Care/ Orders- Physician Authorization
Plan of Care (aka 485) and Interim/ Addendum orders Must be Authorized by a Physician
Client must be under the care of a physician
Physician must be qualified to sign the plan of care and orders
FULL RANGE PHYSICAL THERAPY

17. FULL RANGE PHYSICAL THERAPY
The Plan of Care
Must be updated and reviewed every 60 days and any changes to the POC
In order to bill Medicare services you are providing, the POC must be signed prior to submission of the bill to the insurance.
The orders must be signed within 28 days.
FULL RANGE PHYSICAL THERAPY

18. Plan of Care/ Order Requirements
Verbal Orders- what are they?
Communication with a physician following verbal communication
A “Physician Verbal Order” is required for:
Changes in visit frequency (will update calendar)
Changes to the medications list
Additional disciplines
New interventions
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19. Determining Appropriate POC
Intermittent Care
More than 4 visits per week is considered above intermittent
Average visit frequency is 2x per week by discipline
“Eval Only”??
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20. FULL RANGE PHYSICAL THERAPY
Skilled Service
Clients who have a condition that has reasonable potential for complication and requires skilled observation would be eligible for coverage
Skilled services can be provided by a nurse, PT or ST.
Skilled service must be provided by an RN or LPN under the supervision of a RN
Categories of skilled nursing
Observation and evaluation, treatments and procedures, teaching and training, and management and evaluation of the care plan.
FULL RANGE PHYSICAL THERAPY

21. Part-time and Intermittent
Part-time- SN and aide services combined may not exceed 8 hours per day or 35 hours per week.
Intermittent- and individual must have a medically predicable recurring need for skilled services every days
One time nurse visits are not allowable
FULL RANGE PHYSICAL THERAPY

22. Coverage Guidelines for PT
The need for PT is based on documentation of:
Deficit in self care
Mobility and Balance
Safety
Range of motion
Strength
FULL RANGE PHYSICAL THERAPY

23. Coverage Criteria for Speech Therapy
Patients with speech or language problems, including cognition
Clients with difficulty swallowing
FULL RANGE PHYSICAL THERAPY

24. Coverage Guidelines for OT
Medicare will cover OT services designed to restore or improve the level of function of a client
OT can assess the client’s home for safety and suggest modifications to improve the client’s ability to function independently
FULL RANGE PHYSICAL THERAPY

25. Coverage Guidelines for Medical Social Worker
MSW can provide:
Psychosocial assessments
Financial- environmental assessments,
Counseling
Short term therapy
Community resource planning
Long range planning
FULL RANGE PHYSICAL THERAPY

26. Therapy Reassessments-When?
When must we reassess
At least every 30 days (per discipline)
No individual discipline can go > 30 days from eval or previous reassessment
30 Day time frame restarts with each reassessment
Reassessments can be completed any time within 30 days
Best practice not to wait until the last few days before the 30th
FULL RANGE PHYSICAL THERAPY

27. Therapy Reassessment: How?
How are therapy reassessments completed?
Objective Tests/Measures required for ALL clients
Reassessing progress (and retesting objective measures) at specific visit/time points
Providing a Clinically Supportable reason to continue
Must be completed by a PT/OT/SLP
Cannot not be completed by an assistant
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28. Therapy Reassessment Concepts
Consistent with evaluation of function..
Functional deficits
Captured at OASIS/Therapy Evaluation
Detailed Prior Level of Function
FULL RANGE PHYSICAL THERAPY

29. FULL RANGE PHYSICAL THERAPY
Best Practice
Prior Level of Function (PLOF) is a realistic goal
Document what that is
Document by exception
Every visit. “What can’t the client do?”
Should correspond with the interventions and goals
Always use outcome measures
Retest often
Upgrade as needed
Interventions
Why does this require the skill of a therapist
Teaching, instruction, cues, safety
FULL RANGE PHYSICAL THERAPY

30. FULL RANGE PHYSICAL THERAPY
Paperwork Required
At Discharge:
Discharge Instructions
HHCCN- for discipline
Use when other disciplines are still completing visits
Notice of discharge from discipline
NOMNC- for agency discharge
Must be signed at least 48 hours before final visit
Notice of discharge from all services
FULL RANGE PHYSICAL THERAPY

31. FULL RANGE PHYSICAL THERAPY
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