Home Health & Hospice Week

One sloppy record entry could cost you hundreds of dollars under the prospective payment system changes that hit Jan. 1, so your therapists had better kick up their documentation a notch.

Currently, a denial of a visit or two only matters when the patient is right at or above the 10-visit therapy threshold. But under the new PPS refinements, home health agencies will receive extra payment for most therapy visits between six and 20, pointed out consultant and physical therapist Cindy Krafft in a recent Eli-sponsored audioconference about PPS therapy changes. That means a denial almost anywhere in that spectrum will hurt your bottom line.

“Our risk is almost bigger because of the different opportunities for failure,” Krafft cautioned. “We have to make sure that medical necessity is correct.”

Example: A patient with 14 visits will earn $3,468 under the PPS refinements. But a mere two visit denials, knocking the episode down to 12 total visits, will result in a $419 loss to the episode payment.

Another example: A patient with 23 therapy visits would garner $5,310, but a five-visit denial would bring that down by $1,116, Krafft explained in the conference, “Standing on the Threshold: How HHAs’ 2008 PPS Rule Impacts Your Therapy Practice.”

“The tiered system will make each and every therapy visit note a critical piece in keeping the level of reimbursement earned,” stressed Krafft, with Fazzi As-sociates based in Northampton, MA.

How Good Is Your Charting Tool?

HHAs seeking to bulletproof their therapy documentation should start with the documentation tool. Whether it’s electronic or paper-based, the tool should not leave gaps or omit triggers for essential documentation elements.

For instance: If you find your therapists aren’t recording home exercise programs, check and see whether your charting document or program has a specific place for them. Saying that your software didn’t give you a place to put it won’t help when you’re audited, Krafft noted.

Key elements: Your therapy record should contain these four main components: subjective information; objective measurements and tests; the assessment; and the care plan. “Those all need to be evident in documentation,” Krafft counseled.

And be sure to be extra-thorough with documentation when therapists are doing something rather unexpected.

Example: PTs generally are known for working on ambulation issues. So when a PT works with a patient who is bedbound, it may raise medical reviewers’ eyebrows.

The therapist should highlight the need for PT care--for example, helping with positioning and pressure relief, transferring and caregiver education. “I want to be very, very clear in my documentation why I’m there,” Krafft noted. Spell out the non-walking-related needs the patient has.

Don’t Celebrate Independence Prematurely

A major red flag that leads to therapy visit denials is using the word “independent” incorrectly, Krafft also warned.

Reviewers look at a note saying a patient is independent and will conclude that the patient needs no further therapy or assistance.

Do this: That means therapists have to be very accurate in use of this word. They shouldn’t employ it if the patient needs any more help at all with the skill in question. The patient is only truly independent when they have no need for further improvement in the area.

The word is “being taken very literally on review,” Krafft cautioned. Reviewers think it indicates “that this is not an issue for the patient, it’s safe for them to do this, there’s no need for intervention.”

Patient scenario: A therapist may describe a patient as independent in gait and ambulation, then continue to see her for strengthening to avoid a fall. In this case, the therapist shouldn’t use the term “independent,” because it means the patient doesn’t need any more help with the skill, Krafft advised. v