Cindy Krafft
Pam Warmack
The new therapy thresholds, more than any other element of the 2008 PPS changes, are proving a Medicare payment hazard many home health agencies hadn’t anticipated. During this audio conference, presenter Cindy Krafft of Fazzi Associates gives you some of the most frequently occurring mistakes and provides you with solutions that can help your bottom line:
- The admitting nurse incorrectly answers M0826 (therapy need) with an “n/a” since there is no therapy planned. Result: Absent a number, the agency won’t get paid for the episode.
- Clinicians interpret “indicated need” for therapy to mean as many therapy visits as you want. Despite the PPS changes, medical necessity, not a physician’s order, remains the standard for services. Result: Audits are identifying hundreds of thousands of dollars that agencies owe Medicare because they disregarded the standard.
- Agencies are targeting the new “good numbers” for therapy visits -- at least 6, 14 or more than 20 – regardless of the patient’s actual therapy needs. Result: An appearance of system-gaming that attracts the unwanted attention of your fiscal intermediary and the Office of Inspector General.
You’ll also hear the case history of an agency that helped both its bottom line and outcomes by substituting occupational therapy visits for aide visits, when appropriate. Consultant Pam Warmack will describe how a 1,300-patient home health agency achieved that result with an initial 10 patients deemed capable of ADL improvements.
Each of those patients would have received five aide visits a week, or about 450 visits for the group overall. But by giving them 12 OT visits in addition to PT visits, United was able to reduce aide visits to only twice weekly for nine of the patients, and to three times weekly for the tenth. The added cost of the OT visits was more than offset by the higher episode payments that resulted.
