WE LOVE OUR THERAPISTS! To learn more about the February Learning “Oppties” program, please read the introductory articleposted January 31. Today’s Learning “Opptie” is related to billing the proper mode of treatment. There are 3 modes of treatment defined in the RAI Manual: Individual, Concurrent and Group. Individual treatment is defined as the treatment of one resident at a time. The resident has the full attention of the therapist or therapist assistant for the treatment. Concurrent treatment for a Medicare Part A patient is defined as the treatment of two residents, who are not performing the same or similar activities, at the same time, both of whom must be in the line of sight of the treating therapist or assistant, regardless of payer. For Medicare Part B, however, the treatment of two or more residents who may or may not be performing the same or similar activity, regardless of payer source, at the same time is documented as group treatment. While group treatment for a Medicare Part A resident is defined as the treatment of 4 residents, regardless of payer source, who are performing the same or similar activities, and are supervised by a therapist or assistant who is not supervising any other individuals.
Whew! Did you get all of that information? Well, let’s put it into application with the following challenge:
Mrs. V, whose stay is covered by SNF PPS Part A benefit, begins therapy in an individual session. After 13 minutes the therapist begins working with Mr. S., whose therapy is covered by Medicare Part B, while Mrs. V. continues with her skilled intervention and is in line-of-sight of the treating therapist. The therapist provides treatment during the same time period to Mrs. V. and Mr. S. for 24 minutes who are not performing the same or similar activities, at which time Mrs. V.’s therapy session ends. The therapist continues to treat Mr. S. individually for 10 minutes. Based on the information above, what is the answer to the following questions?
—For how many minutes did Mrs. V. receive individual therapy? For how many minutes did she receive concurrent therapy?
— For which mode of treatment did Mr. S. receive 24 minutes? And, for which mode did he receive 10 minutes? (HINT: Use the Medicare Part B definition).
Mrs. V Individual-13 minutes
Concurrent-12 minutes
Mrs. S. Group–24 minutes
Individual–10 minutes
Wow, Betsy! You are right on and this was a challenge! Thank you for your participation in our Learning “Oppties” program! I am starting to see you move ahead on the most consistent responses list :). Keep it up! How about getting the entire team involved and make a play for one of our team awards this week? Betsy, in all seriousness, thank you for your leadership and thank you, again, for your participation! Deb Bielek, Therapy Resource
Mrs. V Individual-13 minutes
Concurrent-12 minutes
Mrs. S. Group–24 minutes
Individual–10 minutes
EXCELLENT, JANE! You remembered the rule about how to bill a Medicare Part B patient who is being treated with one other patient. While the non-Part B patient may be billed as a “concurrent” treatment, the Part B must be billed as a group treatment. You also picked up on the different start times for the two patients. Way to go. Thank you so much for participating in Learning “Oppties”. You have been entered to win one of this week’s “Oppties” awards. Please be sure to check back tomorrow for another challenge and encourage your team to get involved, too! We have individual and team awards throughout the week. Thank you, again, for participating. Deb