Guest guest Posted May 11, 2011 Report Share Posted May 11, 2011 Hi Todd, First there has to be a check of your state practice act rules (if any) on documentation, what specifically a PT can do and what specifically a PTA can do. If there is anything spelling out that only a PT can discharge a patient, then you may run into trouble. There is nothing, to my knowledge ( I could be wrong on this so I hope that someone else will clarify), that clearly defines what a " Discharge " actually is. At our outpatient clinic and because our state rules are not clear on this, we actually created our own policy that distinguishes between a " Discharge " and " Discontinued care " . Your example below would fall under discontinued care and would be something a PTA could document. The only thing we would add would be some proof of the PTA alerting the primary PT on the case. We have a small clinic so it would be a communication thing but you could handle it also by something documented in the note (primary PT alerted to end of care " ) or having the PT co-sign as a proof of communication. The main thing a reviewer would be concerned with is proving that the primary PT responsible for this patient was aware of the end of service. For us the only " discharges " are completion of expected course of PT, a physician requested discharge or a medical discharge. Just about everything else is discontinued care such as patients not returning, ending care early due to financial reasons, etc. M. Howell, P.T., M.P.T. Howell Physical Therapy Eagle, Idaho thowell@... This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email. PTA DC a patient Group, we have always had our PT's do a DC on a patient which I think is best practice. However, we are running into occasions where the pt doesn't show for 3 visits and does not return phone calls, etc. If they don't show on the PTA for the 3rd visit, etc, can the PTA write a DC note to state reason for DC, etc. There is not assessment or objective information needed, the pt just disappeared. I am unaware of any regulations on DC protocol and hope that you can help provide some clarity. Thanks in advance. Todd Mourning, PT, DPT Manager Rehabilitation Services Abraham Lincoln Memorial Hospital 200 Stahlhut Drive Lincoln, IL 62656 *: 7: Direct *: mourning.todd@... ________________________________ This message (including any attachments) contains confidential information intended for a specific individual and purpose, and is protected by law. If you are not the intended recipient, you should delete this message. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 11, 2011 Report Share Posted May 11, 2011 Hi Todd, First there has to be a check of your state practice act rules (if any) on documentation, what specifically a PT can do and what specifically a PTA can do. If there is anything spelling out that only a PT can discharge a patient, then you may run into trouble. There is nothing, to my knowledge ( I could be wrong on this so I hope that someone else will clarify), that clearly defines what a " Discharge " actually is. At our outpatient clinic and because our state rules are not clear on this, we actually created our own policy that distinguishes between a " Discharge " and " Discontinued care " . Your example below would fall under discontinued care and would be something a PTA could document. The only thing we would add would be some proof of the PTA alerting the primary PT on the case. We have a small clinic so it would be a communication thing but you could handle it also by something documented in the note (primary PT alerted to end of care " ) or having the PT co-sign as a proof of communication. The main thing a reviewer would be concerned with is proving that the primary PT responsible for this patient was aware of the end of service. For us the only " discharges " are completion of expected course of PT, a physician requested discharge or a medical discharge. Just about everything else is discontinued care such as patients not returning, ending care early due to financial reasons, etc. M. Howell, P.T., M.P.T. Howell Physical Therapy Eagle, Idaho thowell@... This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email. PTA DC a patient Group, we have always had our PT's do a DC on a patient which I think is best practice. However, we are running into occasions where the pt doesn't show for 3 visits and does not return phone calls, etc. If they don't show on the PTA for the 3rd visit, etc, can the PTA write a DC note to state reason for DC, etc. There is not assessment or objective information needed, the pt just disappeared. I am unaware of any regulations on DC protocol and hope that you can help provide some clarity. Thanks in advance. Todd Mourning, PT, DPT Manager Rehabilitation Services Abraham Lincoln Memorial Hospital 200 Stahlhut Drive Lincoln, IL 62656 *: 7: Direct *: mourning.todd@... ________________________________ This message (including any attachments) contains confidential information intended for a specific individual and purpose, and is protected by law. If you are not the intended recipient, you should delete this message. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 11, 2011 Report Share Posted May 11, 2011 Only physical therapists discharge patients from physical therapy. Not PTAs, not MDs, not case managers, not insurance companies. I can see however, on your case how you may want to save the PT from mindless work - Have the PTA write it and the PT sign it if that's the case, being that you'll be discharging due to non-compliance or such, OR have the PTA write " per ' , PT' order, patient being discharged from his care due to non-compliance with scheduled appointments (or whatever the case is) and the PTA signs in this case. Only PTs accept patients into PT. Only PTs discharge " cases off PT " . Armin Loges, PT Tampa, FL PTA DC a patient Group, we have always had our PT's do a DC on a patient which I think is best practice. However, we are running into occasions where the pt doesn't show for 3 visits and does not return phone calls, etc. If they don't show on the PTA for the 3rd visit, etc, can the PTA write a DC note to state reason for DC, etc. There is not assessment or objective information needed, the pt just disappeared. I am unaware of any regulations on DC protocol and hope that you can help provide some clarity. Thanks in advance. Todd Mourning, PT, DPT Manager Rehabilitation Services Abraham Lincoln Memorial Hospital 200 Stahlhut Drive Lincoln, IL 62656 *: 7: Direct *: mourning.todd@... ________________________________ This message (including any attachments) contains confidential information intended for a specific individual and purpose, and is protected by law. If you are not the intended recipient, you should delete this message. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 11, 2011 Report Share Posted May 11, 2011 Sounds like the patient discharged themselves and it would be an administrative note to document what happened. PTA DC a patient Group, we have always had our PT's do a DC on a patient which I think is best ractice. However, we are running into occasions where the pt doesn't show for 3 isits and does not return phone calls, etc. If they don't show on the PTA for he 3rd visit, etc, can the PTA write a DC note to state reason for DC, etc. here is not assessment or objective information needed, the pt just isappeared. I am unaware of any regulations on DC protocol and hope that you an help provide some clarity. Thanks in advance. odd Mourning, PT, DPT �Manager �Rehabilitation Services � braham Lincoln Memorial Hospital �200 Stahlhut Drive �Lincoln, IL 62656 � : �7: �Direct �*: mourning.todd@... ________________________________ his message (including any attachments) contains confidential information ntended for a specific individual and purpose, and is protected by law. If you re not the intended recipient, you should delete this message. Any disclosure, opying, or distribution of this message, or the taking of any action based on t, is strictly prohibited. Non-text portions of this message have been removed] ------------------------------------ In ALL messages to PTManager you must identify yourself, your discipline and our location or else your message will not be approved to send to the full roup. Physician Self Referal/Referral for Profit {POPTS} is a serious threat to our rofessions. PTManager is not available to support POPTS-model practices. The escription of PTManager group includes the following: PTManager believes in and supports Therapist-owned Therapy Practices ONLY " essages relating to " how to set up a POPTS " will not be approved PTManager encourages participation in your professional association. Join APTA, OTA or ASHA and participate now! Follow Kovacek, PT on Facebook or Twitter. TManager blog: http://ptmanager.posterous.com/ ahoo! Groups Links Individual Email | Traditional http://docs.yahoo.com/info/terms/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 11, 2011 Report Share Posted May 11, 2011 Where is Rick Gawenda when you need him? I attended one of his audio conferences and I know that he addressed this issue. This is my understanding of the pertinent facts and the practice at our clinic (part B:) 1. Medicare requires a therapist to write progress reports, and Medicare does not consider the PTA a therapist. 2. Medicare requires the therapist who established the plan of care to do the progress reports, and considers a discharge summary a progress report. 3. Medicare does not make a distinction of whether the therapist initiated the discharge or the patient., it's still a discharge. The PT can consult with the PTA, review his/her notes, etc. but the responsibility for generating the report is the PT's. Rick, if you can hear me, please correct me if I misinterpreted. Diane , PT Augusta, GA > > > Sounds like the patient discharged themselves and it would be an > administrative note to document what happened. > > > PTA DC a patient > > Group, we have always had our PT's do a DC on a patient which I think is > best > ractice. However, we are running into occasions where the pt doesn't show > for 3 > isits and does not return phone calls, etc. If they don't show on the PTA > for > he 3rd visit, etc, can the PTA write a DC note to state reason for DC, etc. > > here is not assessment or objective information needed, the pt just > isappeared. I am unaware of any regulations on DC protocol and hope that > you > an help provide some clarity. Thanks in advance. > > odd Mourning, PT, DPT �Manager �Rehabilitation Services � > > braham Lincoln Memorial Hospital �200 Stahlhut Drive �Lincoln, IL 62656 � > : �7: �Direct �*: > mourning.todd@... > > ________________________________ > his message (including any attachments) contains confidential information > ntended for a specific individual and purpose, and is protected by law. If > you > re not the intended recipient, you should delete this message. Any > disclosure, > opying, or distribution of this message, or the taking of any action based > on > t, is strictly prohibited. > > Non-text portions of this message have been removed] > > ------------------------------------ > In ALL messages to PTManager you must identify yourself, your discipline > and > our location or else your message will not be approved to send to the full > roup. > Physician Self Referal/Referral for Profit {POPTS} is a serious threat to > our > rofessions. PTManager is not available to support POPTS-model practices. > The > escription of PTManager group includes the following: > PTManager believes in and supports Therapist-owned Therapy Practices ONLY " > essages relating to " how to set up a POPTS " will not be approved > PTManager encourages participation in your professional association. Join > APTA, > OTA or ASHA and participate now! > Follow Kovacek, PT on Facebook or Twitter. > TManager blog: http://ptmanager.posterous.com/ > ahoo! Groups Links > Individual Email | Traditional > > http://docs.yahoo.com/info/terms/ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 11, 2011 Report Share Posted May 11, 2011 Good point and one I forgot. I was also speaking to outpatient practice. The original post is not clear whether we were talking out inpatient or outpatient. Beside state law, Medicare policy comes into play. Here is the info from the Medicare Benefits Policy Manual (for Part B services): “The Discharge Note is required for each episode of treatment. The Discharge Note shall be a Progress Report written by a clinician, and shall cover the reporting period from the last Progress Report to the date of discharge. In the case of a discharge unanticipated in the plan or previous Progress Report, the clinician may base any judgments required to write the report on the Treatment Notes and verbal reports of the assistant or qualified personnel. In the case of a discharge anticipated within 3 treatment days of the Progress Report, the clinician may provide objective goals which, when met, will authorize the assistant or qualified personnel to discharge the patient. In that case, the clinician should verify that the services provided prior to discharge continued to require the skills of a therapist, and services were provided or supervised by a clinician. The Discharge Note shall include all treatment provided since the last Progress Report and indicate that the therapist reviewed the notes and agrees to the discharge. At the discretion of the clinician, the discharge note may include additional information; for example, it may summarize the entire episode of treatment, or justify services that may have extended beyond those usually expected for the patient’s condition. Clinicians should consider the discharge note the last opportunity to justify the medical necessity of the entire treatment episode in case the record is reviewed. The record should be reviewed and organized so that the required documentation is ready for presentation to the contractor if requested.†The Manual defines “clinician†as a PT in this case and specifically excludes assistants. So bottom line, with Medicare clients in an outpatient setting, the PT needs to complete the note. For inpatient practice, I would defer to others. M. Howell, P.T., M.P.T. Howell Physical Therapy Eagle, Idaho thowell@... This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email. From: PTManager [mailto:PTManager ] On Behalf Of Diane Sent: Wednesday, May 11, 2011 8:08 PM To: PTManager Subject: Re: PTA DC a patient Where is Rick Gawenda when you need him? I attended one of his audio conferences and I know that he addressed this issue. This is my understanding of the pertinent facts and the practice at our clinic (part B:) 1. Medicare requires a therapist to write progress reports, and Medicare does not consider the PTA a therapist. 2. Medicare requires the therapist who established the plan of care to do the progress reports, and considers a discharge summary a progress report. 3. Medicare does not make a distinction of whether the therapist initiated the discharge or the patient., it's still a discharge. The PT can consult with the PTA, review his/her notes, etc. but the responsibility for generating the report is the PT's. Rick, if you can hear me, please correct me if I misinterpreted. Diane , PT Augusta, GA On Wed, May 11, 2011 at 8:55 PM, <Malacroix@... <mailto:Malacroix%40aol.com> > wrote: > > > Sounds like the patient discharged themselves and it would be an > administrative note to document what happened. > > > PTA DC a patient > > Group, we have always had our PT's do a DC on a patient which I think is > best > ractice. However, we are running into occasions where the pt doesn't show > for 3 > isits and does not return phone calls, etc. If they don't show on the PTA > for > he 3rd visit, etc, can the PTA write a DC note to state reason for DC, etc. > > here is not assessment or objective information needed, the pt just > isappeared. I am unaware of any regulations on DC protocol and hope that > you > an help provide some clarity. Thanks in advance. > > odd Mourning, PT, DPT �Manager �Rehabilitation Services � > > braham Lincoln Memorial Hospital �200 Stahlhut Drive �Lincoln, IL 62656 � > : �7: �Direct �*: > mourning.todd@... <mailto:mourning.todd%40mhsil.com> <mailto:mourning.todd@... <mailto:mourning.todd%40mhsil.com> > > > ________________________________ > his message (including any attachments) contains confidential information > ntended for a specific individual and purpose, and is protected by law. If > you > re not the intended recipient, you should delete this message. Any > disclosure, > opying, or distribution of this message, or the taking of any action based > on > t, is strictly prohibited. > > Non-text portions of this message have been removed] > > ------------------------------------ > In ALL messages to PTManager you must identify yourself, your discipline > and > our location or else your message will not be approved to send to the full > roup. > Physician Self Referal/Referral for Profit {POPTS} is a serious threat to > our > rofessions. PTManager is not available to support POPTS-model practices. > The > escription of PTManager group includes the following: > PTManager believes in and supports Therapist-owned Therapy Practices ONLY " > essages relating to " how to set up a POPTS " will not be approved > PTManager encourages participation in your professional association. Join > APTA, > OTA or ASHA and participate now! > Follow Kovacek, PT on Facebook or Twitter. > TManager blog: http://ptmanager.posterous.com/ > ahoo! Groups Links > Individual Email | Traditional > > http://docs.yahoo.com/info/terms/ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2011 Report Share Posted May 12, 2011 According to the CMS IOM Pub.100-02 Medicare Benefit Policy Manual, Chapter 15 section 220.3 – Documentation requirements for Therapy Services; D. Progress Report; “The Discharge Note(or Discharge Summary) is required for each episode of outpatient treatment. ……. The Discharge Note shall be a Progress Report written by a clinician, and shall cover the reporting period from the last plan or previous Progress Report to the date of discharge.” It continues (emphasis added) “In the case of a discharge unanticipated in the plan or previous Progress Report, the clinician may base any judgments required to write the report on the Treatment Notes and verbal reports of the assistant or qualified personnel.” This makes the requirement very clear, so if the patient is non-compliant with the plan and stops treatment, a discharge note is still required to summarize the progress made and justify medical necessity for payment. As with other payers, you look at their requirements and your state practice act. Hope this helps, ine ine M. o, PT Owner Encompass Consulting & Education, LLC 8114 NW 100th Terrace, Tamarac, FL 33321-1259 We work hard to make sure you are " getting it right from the start " . Visit our website at <http://www.encompassmedicare.com/> www.encompassmedicare.com and see what we can do for you. While there sign up for our free e-mail Newsletter " Medicare News and Rules for Therapists " . We specialize in consulting services, seminars and customized education services to providers of Medicare rehabilitation therapy and related services. NOTICE: This communication is intended only for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If the reader of this communication is not the intended recipient or the employee or agent responsible for delivering the communication, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify me immediately by replying to this email. From: PTManager [mailto:PTManager ] On Behalf Of Armin Loges Sent: Wednesday, May 11, 2011 4:53 PM To: PTManager Subject: Re: PTA DC a patient Only physical therapists discharge patients from physical therapy. Not PTAs, not MDs, not case managers, not insurance companies. I can see however, on your case how you may want to save the PT from mindless work - Have the PTA write it and the PT sign it if that's the case, being that you'll be discharging due to non-compliance or such, OR have the PTA write " per ' , PT' order, patient being discharged from his care due to non-compliance with scheduled appointments (or whatever the case is) and the PTA signs in this case. Only PTs accept patients into PT. Only PTs discharge " cases off PT " . Armin Loges, PT Tampa, FL PTA DC a patient Group, we have always had our PT's do a DC on a patient which I think is best practice. However, we are running into occasions where the pt doesn't show for 3 visits and does not return phone calls, etc. If they don't show on the PTA for the 3rd visit, etc, can the PTA write a DC note to state reason for DC, etc. There is not assessment or objective information needed, the pt just disappeared. I am unaware of any regulations on DC protocol and hope that you can help provide some clarity. Thanks in advance. Todd Mourning, PT, DPT Manager Rehabilitation Services Abraham Lincoln Memorial Hospital 200 Stahlhut Drive Lincoln, IL 62656 *: 7: Direct *: mourning.todd@... <mailto:mourning.todd%40mhsil.com> <mailto:mourning.todd@... <mailto:mourning.todd%40mhsil.com> > ________________________________ This message (including any attachments) contains confidential information intended for a specific individual and purpose, and is protected by law. If you are not the intended recipient, you should delete this message. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited. Quote Link to comment Share on other sites More sharing options...
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