RE: FW: Medicare cutoff battle brewing: 'I feel they wrote me off'

[Guest guest]

" Nationwide, the Medicare Advocacy Center helped about 40,000 people

challenge Medicare therapy cutoffs in 2008. Although the cases take time,

judges overturn coverage denials in 70% of cases, Stein said. "

An important line from the article. It is also important to remember that

in most cases with outpatient therapy that the therapist is often the one

with the control over when the client's care is stopped (via the

certification process). In other cases we may have to educate the

physician, supervisor or administrator but we still have a measure of

control in this situation. This is a good article and it made me think of

some things to recommend:

1. Knowing that 70% of denials get overturned then we must find ways, and

teach our staff to find ways, to continue therapy instead of ending it in

these cases. Don't cut them off. Even if you have to see them for free

while they appeal, don't cut them off!

2. Use a client's case like this as a teaching moment to teach your staff

Medicare rules and how to continue care in these cases.

3. Within those rules, find a way, using " reasonable and necessary " and any

relevant outcome measure as well as quality of life and risk for decline to

justify that care should continue.

4. Educate supervisors, administrators and physicians constantly on why to

continue therapy. Use the statistic above as a reference

5. Make sure your staff educates these particular at risk clients to file an

appeal.

I don't think that there are many therapists out there that have not been in

a situation where you knew that a client (of any insurance) was not making

" progress " as defined by insurance but still benefited from therapy, but,

were required to discharge them. It is high time that we improve the system

of handling this situation. There must also be new rules with proper

regulations to screen out those clients that truly do not need more therapy

and to screen out those that have family or aides available that can be

taught to do necessary care.

Tom Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, ID

thowell@...

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From: PTManager [mailto:PTManager ] On Behalf

Of andrew priestap

Sent: Friday, February 04, 2011 5:40 PM

To: ptmanager

Subject: FW: Medicare cutoff battle brewing: 'I feel they wrote

me off'

Very interesting article in Detroit Free Press regarding coverage of Therapy

Services. Front page also, good publicity and pro- therapy!

> From: apriestap@... <mailto:apriestap%40msn.com>

> Subject: Medicare cutoff battle brewing: 'I feel they wrote me off'

> To: apriestap@... <mailto:apriestap%40msn.com>

> Date: Fri, 4 Feb 2011 19:35:43 -0500

>

>

>

> You have been sent an online news article from Andy as a courtesy of

Freep.com.

>

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> Article Title:

> Medicare cutoff battle brewing: 'I feel they wrote me off'

>

> To view the contents on www.freep.com, go to:

> http://www.freep.com/article/201102040300/NEWS06/102040414

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