Therapy:
Sharpen Your Therapy Prediction To Master New Service Domain
Published on Mon May 21, 2007
Every therapy visit could make a difference under revised PPS billing.
You’ll see big changes to how therapy affects your Medicare payments under the proposed prospective payment system--and an incentive to kick your therapy evaluations into gear.
Out with the old: The industry met with glee the Centers for Medicare & Medicaid Services plan to eliminate the OASIS item on prior inpatient stays (M0175) from PPS’ service domain.
In with the new: That leaves the case mix question on therapy utilization as the only item in the service domain, confirms consultant and therapist Cindy Krafft with UHSA in Atlanta.
And CMS wants to change the question from M0825 (Therapy Need: Does the care plan of the Medicare payment period for which this assessment will define a case mix group indicate a need for therapy (physical, occupational, or speech therapy) that meets the threshold for a Medicare high-therapy case mix group?) to M0826 (Therapy Need: In the home health plan of care … what is the indicated need for therapy visits (total of reasonable and necessary physical, occupational, and speech-language pathology visits combined)?)
Home health agencies will have to enter an exact number of predicted therapy visits in response to M0826, explains Betty Gordon with Simione Consultants in Westborough, MA. If there are no therapy visits necessary, providers must submit “0” as the response.
CMS also plans drastic changes to how PPS reimburses for therapy. Instead of one 10-visit threshold that adds an extra $2,000 to the episode payment, CMS proposes a three-tier threshold with bumps in payment at 6, 14 and 20 visits (see Eli’s HCW, Vol. XVI, No. 16). And the new system will include “smoothing” payments for therapy visits between seven and 19, explained consultant Mark Sharp in an Eli-sponsored audioconference on the PPS revisions. Therapist Communication More Important Than Ever Asking HHAs to exactly predict the number of therapy visits for a patient’s episode is a tall order. All kinds of factors can easily change the prediction, Krafft points out. For example, the patient can progress more quickly or slowly than originally predicted or the patient may refuse care.
To increase their accuracy in predicting therapy, agencies may have to adjust their therapy evaluation procedures, Gordon suggests. HHAs will have to strive to get their therapists in to evaluate the patient as soon as possible after admission, she urges.
Bright side: Many agencies are already achiev-ing very quick therapy evaluations, believes therapist David Perry with Perry Therapeutics in Grosse Pointe Woods, MI. That’s due to competitive pressures.
But HHAs will [...]
