Eli's Rehab Report

Question: My staff works in a hospital-based outpatient facility. We also work for our hospital-based HHA. When we're seeing a patient in home health and we discharge him from that setting, and he becomes an outpatient, do we need to do an initial eval for that patient in the hospital outpatient setting, or do we only need to do a re-eval?

California Subscriber

Answer: You need to do an initial evaluation because the hospital outpatient setting has a whole new payment methodology. In addition, there could likely be a different therapist working with the patient. But beyond even that, the CMS manual says that you need to do a new evaluation for a new diagnosis or a new treatment setting. CMS has also recently clarified that patients coming from a hospital to a SNF setting need a new evaluation.

Side note: Therapists are looking for further clarification from CMS regarding SNFs such as, when a patient goes from Part A to Part B in a short amount of time, does she need a new eval, or just a re-eval? The American Physical Therapy Association is expecting clarification on this question in 2008.