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Harmony Healthcare International, Inc.Medicare Therapy Documentationin a Skilled Nursing FacilityHARMONY UNIVERSITYThe Provider Unit ofHarmony Healthcare International, Inc. (HHI)Presented by:Carrie Mullin, OTR/L, RAC-CTCorporate Consultant/Denial ManagerElisa Bovee, MS OTR/LVice President of OperationsHousekeepingSign InContact Hours CertificateA Little About MeHandoutsContact Information for QuestionsCopyright 2012 All Rights ReservedHarmony Healthcare International, Inc.2Learning ObjectivesThe learner will be able to summarizeuniversal documentation guidelinesThe learner will be able to determineMedicare Coverage Criteria/Skilled CareThe learner will be able to identify skilledcare terminologyThe learner will be able to compose clinicaldocumentation that supports Part A skilledcareCopyright 2012 All Rights ReservedHarmony Healthcare International, Inc.3Copyright 2012 All Rights Reserved1
Harmony Healthcare International, Inc.Universal DocumentationGuidelinesCreate a complete picture of residentGuides MDRecord physical, mental and emotionalstatusCopyright 2012 All Rights ReservedHarmony Healthcare International, Inc.4Basics of DocumentationClarity: Evidence of the need for further skilledcareContent: Describe what you have done. There isbeginning, middle and end of every goodnursing noteCommunication:Document any changes in the patientDocument what needs to be changedregarding the plan of care, current changes inthe plan of care, medication changes andchanges in therapy servicesCopyright 2012 All Rights ReservedHarmony Healthcare International, Inc.5Basic Medicare RequirementsThe patient requires skilled NursingServices or Skilled RehabilitationServices i.e., services that must beperformed by or under the supervisionof professional or technical personnel(see §§214.1 – 214.3)Copyright 2012 All Rights ReservedHarmony Healthcare International, Inc.6Copyright 2012 All Rights Reserved2
Harmony Healthcare International, Inc.Basic Medicare RequirementsThe patient requires these skilledservices on a daily basis (see §214.5)Daily Nursing NotesTreatment SheetsCopyright 2012 All Rights ReservedHarmony Healthcare International, Inc.7Basic Medicare RequirementsThe patient requires these skilledservices on a daily basis (see §214.5)As a practical matter, consideringeconomy and efficiency, the dailyskilled services can be provided only onan inpatient basis in an SNF (see §214.6)Services need to be provided at a SNF levelof careCopyright 2012 All Rights ReservedHarmony Healthcare International, Inc.8Basic Medicare RequirementsIf any one of these three factors is notsupported by the documentation in thepatient’s record, the SNF stay, eventhough it might include the delivery ofdaily skilled services, will not becoveredCopyright 2012 All Rights ReservedHarmony Healthcare International, Inc.9Copyright 2012 All Rights Reserved3
Harmony Healthcare International, Inc.Skilled Rehabilitation OverviewDirectly related to a written plan oftreatmentRequires knowledge/skills/judgment ofqualified professionalServices must be considered underacceptable standards of clinical practiceExpectation of improvement of restorativepotential in a reasonable and predictableamount of time or Establishment of a safe and effectivemaintenance programCopyright 2012 All Rights ReservedHarmony Healthcare International, Inc.10Medicare Benefit PolicyThe services shall be of such a level ofcomplexity and sophistication or thecondition of the patient shall be suchthat the services required can be safelyand effectively performed only by atherapistCopyright 2012 All Rights ReservedHarmony Healthcare International, Inc.11Skilled Rehabilitation/MD InvolvementThe service must be ordered by a physicianThe therapy intervention must relate directlyand specifically to an active written treatmentregimen established by the physician afterany needed co
Skilled Physical Therapy Application of Guidelines Range of Motion: Only the qualified physical therapist may perform range of motion tests and, therefore, such tests are skilled physical therapy. Range of motion exercises constitute skilled physical therapy only if they are part of actual treatment for a specific disease state
