Home Health & Hospice Week

Is your therapy documentation missing any of these elements?

HHH Medicare Administrative Contractor Palmetto GBA isn’t playing around when it comes to scrutiny of therapy claims, as its recent probe results of nearly 11,900 claims show (see story, p. 162).

Palmetto has required the following 11 elements for years now under its related Local Coverage Decision on home health therapy. In its latest round of medical review results articles, Palmetto stresses that “(t)he physician and/or therapist’s evaluation/re-evaluation assesses the area for which therapy/treatment is being planned. It must be completed prior to beginning therapy. Evaluations must contain the following information:

• Reason for referral
• Diagnosis/condition being treated
• Prior level of function (be specific)
• Evaluations must contain physical and cognitive baseline data necessary for assessing rehabilitation potential and measuring progress
• Current level of function
• Objective measurements such as strength, ROM, pain, ADL level, or edema
• Treatment techniques/modalities selected for treating current illness or injury
• Limitations which may influence the length of treatment
• Short and/or long term goals stated in objective measurable terms, and their expected date of accomplishment
• Frequency and duration of therapy
• Re-assessments must be performed at least every 30 days by a qualified therapist. The 30 day clock begins with the first therapist’s visit/assessment/measurement/documentation.”

Note: For a free PDF copy and link to Palmetto’s 469-page LCD on therapy, email editor Rebecca Johnson at rebeccaj@eliresearch.com with “Palmetto therapy LCD” in the subject line.