WE LOVE OUR THERAPISTS! AND, WE ARE PASSIONATE ABOUT LEARNING! Throughout the month of February, we are providing Learning “Oppties”. To learn more about the February Learning “Oppties” program, please read the introductory article posted January 31. On Tuesday, February 14 (Valentine’s Day), over 14 of our therapists wrote inspiring blogs, sharing stories from the heart. Take a moment to check out some of their writings.
Today’s Learning “Opptie” is related to the recording of time for patient’s receiving services therapy services in a Skilled Nursing Facility. We have spent time discussing the three primary modes of treatment defined by CMS in the RAI Manual for MDS 3.0, v1.07, Section O, Chapter 3. Remember, you can access this manual online at CMS.GOV. Did you know that, according to the RAI manual, a resident may receive therapy via different modes during the same day or even treatment session? When developing the plan of care, the therapist and assistant must determine which mode(s) of therapy and the amount of time the resident receives for each mode and record the minutes appropriately. The therapist and assistant should document the reason a specific mode of therapy was chosen as well as anticipated goals for that mode of therapy.
Here is the Learning “Oppties” 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. How would the therapist code each individual’s treatment? (Hint: Medicare Part B does not allow concurrent billing). Be sure to indicate the name of your facility so that you can be entered to win an “Opptie” prize! Thank you for your participation.
mr v 13 min indivdual/24 min concurrent,mr s 10 min individual.Orchard whittier,ca
Hi, Frank. THIS IS SO COOL! The Orchard is cruising with the team entries! KEEP GOING. You have been entered to win a Learning “Oppties” and may be on track to win the team participation award. Thank you so much for your participation. Your answer is very close to perfect. In addition to the 10 minutes of individual for Mr. S, he will also need to be billed for 24 minutes of Group. Part B does not allow concurrent, but group for Medicare B is defined as the treatment of 2 or more patients at the same time, performing the same or different treatment tasks, which accommodates this example. Frank, thank you so much for your participation in Learning “Oppties”. Be sure to check back for the announcement of winners on Monday. Deb Bielek, Therapy Resource
For Mrs. V, bill 13 minutes individual therapy, 24 minutes of concurrent therapy. For Mr. S., bill 10 minutes of individual therapy.
Kristin Chalmers, PT
The Orchard
Hi, Kristin. Thank you so much for participating in our Learning “Oppties” program. You have been entered to win one of our “Oppties” awards. Please be sure to check back on Monday for the announcement of winners. Your answer is correct, minus ONE detail. Mr. S. should also have 24 minutes of “Group” billed. Medicare Part B does not allow concurrent treatment, but does define group as “the treatment of more than one patient at the same time, performing the same or different treatment tasks”, which accommodates this example. Thank you so much for your participation. Be sure to check back for the announcement of winners on Monday. Deb Bielek, Therapy Resource
Mrs V: capture 37 minutes of therapy with 24 minutes billed as concurrent. ROX will give credit of 12 minutes for the 24.
Mrs S: bill 24 minutes as group (ROX adjusts to 6 minutes), bill additional 10 min for individual
FORGOT TO SAY WHERE I AM WORKING
Mrs V: 37 total minutes with 24 coded as concurrent. ROX will give us credit for 12 min of the 24. We will have a total of 25 after adjustment.
Mrs S: 10 minutes individual, 24 minutes group. ROX will adjust the 24 minutes to 6. We would get credit for 16 minutes.
Hi, Daniel. Thank you so much for your participation in Learning “Oppties”. You are correct. Mrs. V would receive 37 minutes total, with 13 individual and 24 coded concurrent. ROX does split the concurrent minutes in half for the purpose of productivity calculation. It actually happens when the MDS is transmitted, the RUG grouper splits the minutes in half and allows 50% toward the Reimbursable Therapy Minutes (RTM) for the RUG. For Mrs. S, you are correct in how the minutes are recorded in ROX and the MDS. Again, for the purpose of productivity, the therapist will receive 1/4 the minutes of the group and the RUG Grouper will only allow 1/4 for the RTM for the purpose of the RUG calculation. EXCELLENT, DANIEL! You have been entered to win a Learning “Oppties” award! Be sure to check back on Monday for the announcement of winners. Thank you, again, for your participation. Deb Bielek, Therapy Resource
From PVG – Mrs V is billed 13 minutes of individual time and 24 minutes of concurrent. Mr. S is billed 24 minutes of group and 10 minutes of individual.
This was actually completed as a group at our DOR meeting for Northern Pioneers. How many DORs does it take to bill 71 minutes?
Thank you, Lori! I am so happy to have you participating in our Learning “Oppties” program and it is so cool to hear about the great things happening in Northern Pioneers! There is definitely a great camaraderie developing among the therapy leaders. I look forward to spending time with you sometime soon. You have been entered to win an “Opptie” prize. Deb Bielek, Therapy Resource
Mrs. V is charged for 13 minutes of individual time, and 24 minutes of concurrent time (which is halved,) for a total of 25 rug minutes.
Mr. S is charged for 10 minutes of individual time, and 24 minutes of group time (which is quartered,) for a total of 16 minutes, or 1 unit.
Way to Go, Nancy! Thank you so much for your participation in our Learning “Oppties” program. Your answer is correct. Please watch for Learning “Oppties” winners to be announced on Monday. Have a wonderful weekend. Deb Bielek, Therapy Resource
How would the therapist code each individual’s treatment?
Mrs. V 13 min individual
24 min concurrent
Mr. S 10 min individual
24 min group
Hi, Tim. WAY TO GO. You are correct and have been entered to win another Learning “Oppties” award. KEEP THEM COMING, MR. Thank you so much for your participation and the spirit you and the entire Premier Care Team have created for the Learning “Oppties” program. Deb Bielek, Therapy Resouce
Ms V. 13 individual minutes
24 concurrent
Mr. S. 10 individual minutes
24 minutes group
Karin, YES. You are correct! Thank you for participating in our Learning “Oppties” program. Watch for today’s new challenge. You have been entered to win AGAIN! Thank you again for your participation and please enjoy your day in Clarion. Deb Bielek, Therapy Resource
I understand the math and the minute breakdown but I was always taught that you can not treat a Med A and Med B at the same time. Did this new rule change in October and I just missed it?
Hi, Melissa.
YOU ARE CORRECT when it comes to billing “Concurrent”. A Part B patient cannot be seen in a “concurrent” treatment. However, a Part A and a Part B patient CAN be seen together, as long as the Part B patient is billed for group. According to the RAI manual for MDS 3.0, Chapter 3, Section O, “The treatment of two or more residents who may or may not be performing the same or similar ctivity, regardless of payer source, at the same time is documented as group treatment for the Part B patient.” So, you CAN treat a Part A and a Part B simultaneously. The Part B will be recorded as group treatment. The part A patient will be recorded as group,if the group was scheduled with 4 residents and the patients were performing the same or similar activities. If the treatment includes only 2 residents and they are not performing the same or similar activities, then the Part A patient treatment will be recorded as concurrent. It’s a lot to keep straight, but you CAN treat the Part A and Part B patient together. Thank you so much for your question and thank you for participating in Learning “Oppties”. You have been entered to receive an “Oppties” prize. Deb Bielek, Therapy Resource