Learning “Oppties” #7

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. Today’s Learning “Opptie” is related to the RAI Manual for MDS 3.0, v1.07, Chapter 3, Section O (manual can be found by going to cms.gov), rules on billing the different modes of treatment. As a reminder, the modes of treatment include Individual, Concurrent and group. Individual is defined as, “The treatment of one resident at a time.” Concurrent for Medicare Part A is defined as, “The treatment of 2 residents, who are not performing the same or similar activities, at the same time, regardless of payer source, both of whom must be in line-of-sight of the treating therapist or assistant.” And, Group for Medicare Part A 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.”

Using the information above, answer the following “Oppties” challenge. Be sure to include your full name and facility name on your response so that you can be entered to win an “oppties” award. Winners for this week’s challenge will be posted on Monday, February 13.

• An Occupational Therapist provides similar therapies to Mr. W., Mr. X, Mrs. Y and Mr. Z at the same time, for 30 minutes. Mr. W. and Mr. X’s stays are covered under the Medicare SNF PPS Part A benefit. Mrs. Y.’s therapy is covered under a Medicare Advantage Plan, and Mr. Z has private insurance paying for therapy. Based on the information above, answer the following questions: 1. What treatment code would the OT use to indicate the “Mode” of treatment? 2. How many minutes would the OT record for each patient? Good luck!