Home Health & Hospice Week

Ward off denials by adopting the maintenance mindset.

If you think a new provision changing who can provide maintenance therapy doesn’t affect you because your agency doesn’t furnish the service much, think again.

“Every single” home health agency providing therapy is also furnishing maintenance therapy, argues physical therapist Cindy Krafft with Kornetti & Krafft Health Care Solutions.

Take a look: Almost all therapy episodes have visits at the beginning where the patient makes significant functional gains, then a few visits at the end where the improvement drops off. Those last few visits are where therapists want to make sure patients are going to keep what they’ve gained in the course of the other visits, Krafft contends.

Often, in medical review, those visits get lopped off by denials, Krafft observes. That occurs because the patient has reached a point where no more quantifiable gains are achieved.

“It’s much more common to see the last few visits denied, [rather] than all the therapy visits,” Krafft tells Eli.

Reviewers may justly deny those visits for restorative therapy, but what the therapist is doing is actually furnishing maintenance therapy, Krafft argues. Documenting and billing the visits that way can stave off the usual denials, she insists.