RE: In-pt Rehab non-SNF billing

[Guest guest]

My understanding is that it is 180 minutes per day across disciplines.

-Chris

Benfield, P.T.

Director of Rehabilitation

RiverWoods

3201 River Road

burg, PA 17837

Direct:

Main:

Fax:

email: .Benfield@...

Web: www.albrightcare.org <http://www.albrightcare.org/>

________________________________

From: PTManager [mailto:PTManager ] On

Behalf Of ptcan65@...

Sent: Wednesday, October 18, 2006 6:50 PM

To: PTManager

Subject: In-pt Rehab non-SNF billing

Good Evening,

I had question posed to me by a PT working in an In-pt non-SNF facility.

She mentioned that management is telling the therapists that patients

need to receive a minimum of 180 minutes of therapy for 5 of 7 days. The

question is about the calculation of the 180. Is it per day or is it

over 5 days between the disciplines?

Are there any other facilities facing this 180 min rule? Is it tied in

with the " 75% rule " ? Is this done for Medicare patients or is it being

done across the board, regardless of pay source?

Thanks,

A. McKoy, PT, MS, GCS

njoy at RHC

__________________________________________________________

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[Guest guest]

-

The " 3hrs x 5 of 7 consecutive days " rule pertains to Inpatient

Rehabilitation Facilities (IRF), which is the same environment as the " 75%

=> 65% of patients must have one of the Medicare 10 (now 13, and ruling out

Total Joint Arthroplasties s due to Osteoarthritis) diagnoses. IRFs are for

patients who " require, tolerate, and receive " 180 minutes per day, five of

any seven continuous days. If they aren't getting it, then the IRF may lose

its status and revert to acute care hospaital status. This would not be a

good thing.

The three hours means that during each of the five days, the patient gets at

least 180 minutes of PT/OT/SLP or " Therapeutic Recreation " . That means that

looking for 5 x 180 minute during seven days will very absolutely be

unacceptable.

To screen for compliance, grab the patient record and set a timeline of

every day the patient was present in the IRF. Then, grab any seven

continuous days, and look to see whether five of them had 180 minutes or

more of rehab therapies. Then, do the same screen for every seven

continuous days: Day 1-8, Day 2-9, Day 3-10 and so on.

In an unusual circumstance, there may be a documented medical reason why an

IRF patient does not receive all 180 minutes, with a clear plan on when the

staff will have him or her doing all 180 minutes. In that case, a chart

reviewer may decide that the day counts for 80 minutes.

It would not be a good practice to admit patients with hopes to " build them

up to 3 hours " .

Hope that helps!

Dick Hillyer

W. Hillyer, PT, MBA, MSM

Hillyer Consulting

700 El Dorado Pkwy West

Cape Coral, FL 33914

Home

Fax

Mobile

In-pt Rehab non-SNF billing

Good Evening,

I had question posed to me by a PT working in an In-pt non-SNF facility.

She mentioned that management is telling the therapists that patients need

to receive a minimum of 180 minutes of therapy for 5 of 7 days. The

question is about the calculation of the 180. Is it per day or is it over 5

days between the disciplines?

Are there any other facilities facing this 180 min rule? Is it tied in with

the " 75% rule " ? Is this done for Medicare patients or is it being done

across the board, regardless of pay source?

Thanks,

A. McKoy, PT, MS, GCS

njoy at RHC

________________________________________________________________________

Check out the new AOL. Most comprehensive set of free safety and security

tools, free access to millions of high-quality videos from across the web,

free AOL Mail and more.

[Guest guest]

Just want to add one thing to Dick's post...

be careful about using " Therapeutic Recreation " as part of the 3

hours/day... I doubt you're in a state where the FI allows it - if

there are any left... however Dick's in Florida, so maybe Florida is

one of those states!

Ty Keeter DPT, MHA

Southern Oregon

>

> -

>

> The " 3hrs x 5 of 7 consecutive days " rule pertains to Inpatient

> Rehabilitation Facilities (IRF), which is the same environment as

the " 75%

> => 65% of patients must have one of the Medicare 10 (now 13, and

ruling out

> Total Joint Arthroplasties s due to Osteoarthritis) diagnoses.

IRFs are for

> patients who " require, tolerate, and receive " 180 minutes per

day, five of

> any seven continuous days. If they aren't getting it, then the

IRF may lose

> its status and revert to acute care hospaital status. This would

not be a

> good thing.

>

> The three hours means that during each of the five days, the

patient gets at

> least 180 minutes of PT/OT/SLP or " Therapeutic Recreation " . That

means that

> looking for 5 x 180 minute during seven days will very absolutely

be

> unacceptable.

>

> To screen for compliance, grab the patient record and set a

timeline of

> every day the patient was present in the IRF. Then, grab any seven

> continuous days, and look to see whether five of them had 180

minutes or

> more of rehab therapies. Then, do the same screen for every seven

> continuous days: Day 1-8, Day 2-9, Day 3-10 and so on.

>

> In an unusual circumstance, there may be a documented medical

reason why an

> IRF patient does not receive all 180 minutes, with a clear plan on

when the

> staff will have him or her doing all 180 minutes. In that case, a

chart

> reviewer may decide that the day counts for 80 minutes.

>

> It would not be a good practice to admit patients with hopes

to " build them

> up to 3 hours " .

>

>

> Hope that helps!

> Dick Hillyer

>

>

> W. Hillyer, PT, MBA, MSM

> Hillyer Consulting

> 700 El Dorado Pkwy West

> Cape Coral, FL 33914

>

> Home

> Fax

> Mobile

>

> In-pt Rehab non-SNF billing

>

> Good Evening,

>

> I had question posed to me by a PT working in an In-pt non-SNF

facility.

> She mentioned that management is telling the therapists that

patients need

> to receive a minimum of 180 minutes of therapy for 5 of 7 days.

The

> question is about the calculation of the 180. Is it per day or is

it over 5

> days between the disciplines?

>

> Are there any other facilities facing this 180 min rule? Is it

tied in with

> the " 75% rule " ? Is this done for Medicare patients or is it being

done

> across the board, regardless of pay source?

>

> Thanks,

>

> A. McKoy, PT, MS, GCS

> njoy at RHC

>

>

>

_____________________________________________________________________

___

> Check out the new AOL. Most comprehensive set of free safety and

security

> tools, free access to millions of high-quality videos from across

the web,

> free AOL Mail and more.

>

>

>

[Guest guest]

List SErve,

Here is the link to the CMS manual that outlines the

rules and regulations for IRF.

http://www.cms.hhs.gov/manuals/Downloads/bp102c01.pdf

Regarding the 3 hours of therapy 5 out of 7 days, this

information can be found on page 29 of the above link.

Please keep in mind not all Medicare contractors count

recreational therapy towards the 3 hour rule. Check

with your specific contractor.

Rick Gawenda, PT

Director PM & R

Detroit Receiving Hospital

--- Benfield

wrote:

> My understanding is that it is 180 minutes per day

> across disciplines.

>

> -Chris

>

>

>

> Benfield, P.T.

>

> Director of Rehabilitation

>

> RiverWoods

>

> 3201 River Road

>

> burg, PA 17837

>

>

>

> Direct:

>

> Main:

>

> Fax:

>

> email: .Benfield@...

>

> Web: www.albrightcare.org

> <http://www.albrightcare.org/>

>

>

>

>

>

> ________________________________

>

> From: PTManager

> [mailto:PTManager ] On

> Behalf Of ptcan65@...

> Sent: Wednesday, October 18, 2006 6:50 PM

> To: PTManager

> Subject: In-pt Rehab non-SNF billing

>

>

>

> Good Evening,

>

> I had question posed to me by a PT working in an

> In-pt non-SNF facility.

> She mentioned that management is telling the

> therapists that patients

> need to receive a minimum of 180 minutes of therapy

> for 5 of 7 days. The

> question is about the calculation of the 180. Is it

> per day or is it

> over 5 days between the disciplines?

>

> Are there any other facilities facing this 180 min

> rule? Is it tied in

> with the " 75% rule " ? Is this done for Medicare

> patients or is it being

> done across the board, regardless of pay source?

>

> Thanks,

>

> A. McKoy, PT, MS, GCS

> njoy at RHC

>

>

>

__________________________________________________________

> Check out the new AOL. Most comprehensive set of

> free safety and

> security tools, free access to millions of

> high-quality videos from

> across the web, free AOL Mail and more.

>

> [Non-text portions of this message have been

> removed]

>

>

>

>

>

> [Non-text portions of this message have been

> removed]

>

>

>

__________________________________________________

[Guest guest]

Dick,

You reference days 1-8 , 2-9. etc .. is there a reason you do not reference

1-7,etc? We are working to address patients arrival date (day 1), where they do

not get 3 hrs of therapy, and the impact on 5 days/3hrs therapy compliance -

what is your experience on using the first full day on rehab as the roving week

to assess for 5 days/3hrs compliance - so would look at days 2-8 for 3hrs

compliance? We have therapy on Saturdays but doesn't necessarily add up to

3hrs so using the admit day as beginning the roving week brings us up short with

the 3hr compliance ......

Thanks.

Betsy Bjoralt

MeritCare Hospital

Fargo ND

>>> " Dick Hillyer " 10/18/2006 7:39 PM >>>

-

The " 3hrs x 5 of 7 consecutive days " rule pertains to Inpatient

Rehabilitation Facilities (IRF), which is the same environment as the " 75%

=> 65% of patients must have one of the Medicare 10 (now 13, and ruling out

Total Joint Arthroplasties s due to Osteoarthritis) diagnoses. IRFs are for

patients who " require, tolerate, and receive " 180 minutes per day, five of

any seven continuous days. If they aren't getting it, then the IRF may lose

its status and revert to acute care hospaital status. This would not be a

good thing.

The three hours means that during each of the five days, the patient gets at

least 180 minutes of PT/OT/SLP or " Therapeutic Recreation " . That means that

looking for 5 x 180 minute during seven days will very absolutely be

unacceptable.

To screen for compliance, grab the patient record and set a timeline of

every day the patient was present in the IRF. Then, grab any seven

continuous days, and look to see whether five of them had 180 minutes or

more of rehab therapies. Then, do the same screen for every seven

continuous days: Day 1-8, Day 2-9, Day 3-10 and so on.

In an unusual circumstance, there may be a documented medical reason why an

IRF patient does not receive all 180 minutes, with a clear plan on when the

staff will have him or her doing all 180 minutes. In that case, a chart

reviewer may decide that the day counts for 80 minutes.

It would not be a good practice to admit patients with hopes to " build them

up to 3 hours " .

Hope that helps!

Dick Hillyer

W. Hillyer, PT, MBA, MSM

Hillyer Consulting

700 El Dorado Pkwy West

Cape Coral, FL 33914

Home

Fax

Mobile

In-pt Rehab non-SNF billing

Good Evening,

I had question posed to me by a PT working in an In-pt non-SNF facility.

She mentioned that management is telling the therapists that patients need

to receive a minimum of 180 minutes of therapy for 5 of 7 days. The

question is about the calculation of the 180. Is it per day or is it over 5

days between the disciplines?

Are there any other facilities facing this 180 min rule? Is it tied in with

the " 75% rule " ? Is this done for Medicare patients or is it being done

across the board, regardless of pay source?

Thanks,

A. McKoy, PT, MS, GCS

njoy at RHC

__________________________________________________________

Check out the new AOL. Most comprehensive set of free safety and security

tools, free access to millions of high-quality videos from across the web,

free AOL Mail and more.

[Guest guest]

There are still a number of FI/MAC's that allow Therapeutic Recreation. Dick is

correct that it may be counted in Florida. Also, those with Noridian and

Adminastar Federal will have this ability BUT it comes with certain

requirements:

1. The Rec Therapy MUST be goal directed, functionally based

2. TR must be clearly defined in the POC for the patient

Here is the link to the Adminastar Federal site:

www.adminastar.com/Providers/Intermediary/MedicalPolicy/LCDs/IRF.cfm

If you need the specific Noridian responses to our Freedom of Information

Inquiry on the 3-hour rule, please contact me directly for the pdf files.

Angie , PT

President/CEO

Images & Associates

407 South Shore Drive

Amarillo, TX 79118

Phone-

Fax-

Mobile-

Web: www.ptconsultant.com

Email: images@...

Home of The Desktop Consultant: The Rehab Department's Guide to JCAHO

>----- -- In-pt Rehab non-SNF billing

>>

>> Good Evening,

>>

>> I had question posed to me by a PT working in an

>In-pt non-SNF

>facility.

>> She mentioned that management is telling the

>therapists that

>patients need

>> to receive a minimum of 180 minutes of therapy

>for 5 of 7 days.

>The

>> question is about the calculation of the 180. Is

>it per day or is

>it over 5

>> days between the disciplines?

>>

>> Are there any other facilities facing this 180

>min rule? Is it

>tied in with

>> the " 75% rule " ? Is this done for Medicare

>patients or is it being

>done

>> across the board, regardless of pay source?

>>

>> Thanks,

>>

>> A. McKoy, PT, MS, GCS

>> njoy at RHC

>>

>>

>>

>___________________________________________________

>__________________

>___

>> Check out the new AOL. Most comprehensive set of

>free safety and

>security

>> tools, free access to millions of high-quality

>videos from across

>the web,

>> free AOL Mail and more.

>>

>>

>> [Non-text portions of this message have been

>removed]

>>

>>

>>

>>

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>>

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