Re: RE: RE: Re:productivity and ethical/legal limits

[Guest guest]

Please clarify the following post:

>As I understand it, to be able to get in the ULTRA HIGH and HIGH categories,

you have to provide 720

>minutes of therapy in the first five days (of admission - we are not talking

>of the assessment reference dates) with one of the of the discplines providing

>therapy 5 days.

First, the necessity to see the patient for the first 5 days qualifies the

patient for either ultra high or very high. Otherwise, it would behoove us to

use the section T which will take the patient only as high as the " high "

category. My question is this: Are we required to see the patient for the 500

and 720 minutes as required by the assigned " very high " and " ultra high "

categories during the assessment period? I hope that make sense because I think

I just confused myself in writing it.

^^^^^^^^^^^^^^^^

Todd Cepica, P.T.

Assistant Director

Physical Medicine and Rehabilitation

University Medical Center

Lubbock, Tx 79417

Ph: Fax:

ntc@...

Re: RE: Re:productivity and ethical/legal limits

Someone please correct me if I am misinterpreting the previous posts or if I

just simply have the wrong information.

I think we are taking about two separate things here. As I understand it, to

be able to get in the ULTRA HIGH and HIGH categories, you have to provide 720

minutes of therapy in the first five days (of admission - we are not talking

of the assessment reference dates) with one of the of the discplines providing

therapy 5 days. Therefore if your window is, say, day 2-6 you can only count

the therapy treatment minutes given in day 2, 3, 4, 5 (assuming therapy

treatment started on day 2) - and since you did not provide 5 days of

therapy, you cannot be clasified in the ultra high and high categories.

Now comes Section T. Section T allows us to project the number of therapy

minutes in the first 15(?) days of stay in the facility. Use of Section T

allows the patient to be placed in a higher RUGS grouping (highest you can get

on Section T is a Low) which would not have been possible if you defaulted

into the lowest classification by not treating the patient on day one.

So there is absolutely nothing wrong with seeing the patient for therapy on

day 2, 3, so on... but by doing so the patient defaults to a lower RUGs

classification (assuming that the patient could have been potentially be

classified as ultra high or high). As I understood during from the data from

the demonstration states, only 20-25% (?) of the patients were classified as

ultra high and high anyway; most of the patients typically seen in therapy

fell under the classifications below ultra high/ high. That's why there is

talk about audits for facilities with a high percentage of patients falling in

the highest two RUGs classifications.

You need to figure out the difference in the reimbursement between the highest

two categories and the default rate and you will see why therapy companies

want therapists to see that patient on day 1.

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