Eli's Rehab Report

Figure Out Therapy Hold Impact on Home Health Reassessments

If therapy holds are tripping up your reassessment window for the discipline, an educational tool from one HHH MAC may help.

NHIC addresses the issue of therapy that is on hold during the 30-day reassessment deadline. If home health agencies know the hold is going to occur — for instance, while the patient undergoes and recovers from a planned surgery — then the therapist should conduct the reassessment on the last visit before the hold takes effect, the MAC instructs.

If the hold is unexpected, however — say for an unplanned hospitalization during the 30-day deadline — then the therapist can complete the reassessment when the therapy resumes after the hospitalization, NHIC says.

More scenarios are addressed in the tool at www.medicarenhic.com/providers/articles/TherapyReassessmentArticle.pdf.

PTs in New York and Connecticut Have Cause for Celebration

In a move calculated to bring documentation requirements in line with national Medicare policy, two burdensome requirements have been removed in New York and Connecticut. The local MAC, National Government Services Inc (NGS), responded to pleas by APTA by doing so.

The following requirements were removed from its local coverage determination policy: “(1) for progress reports to jump from a frequency of every 10 treatment days to every 5 treatment days after services exceeded the therapy cap, and (2) for documentation of a physician reexamination for services that exceeded either 90 days or the therapy cap,” according to an August 5 news release on the APTA website.

The revised policy will take effect for service provided on or after August 1, the release said. 

Detroit PT Assistant and HHA Co-Owner Pleads Guilty to Fraud

Detroit-area physical therapy assistant, patient recruiter and HHA owner Syed Shah has pled guilty for his role in a $22 million Medicare fraud scheme, according to the Department of Justice.

From 2008 to 2012, Troy, Mich.-based Prestige Home Health Services Inc. paid Shah kickbacks for Medicare beneficiary information that the HHA used to bill Medicare for services that were never rendered or were medically unnecessary, according to plea documents. Shah admitted to signing documents and progress notes indicating he had provided PT services when he hadn’t, according to the DOJ.

When Shah became an owner of Royal Home Health Care Inc. in 2009, it engaged in the same scheme, paying kickbacks for bene information used to bill services that were never furnished or were medically unnecessary.