RE: SNF Contract

December 31, 2008

You need to get a copy of the SNf's contract with the current contract tx

provider and study it. Be sure you understand the non-compete clauses re:

current rehab staff; you may not be able to hire them/ask them to stay.

The SNF owner/ CEO may have in his files an old contract therapy company's

contract that you could look at. Remember that it is old and that things have

changed a lot since PPS was implemented. It would give you some idea though

of what a contract includes.

Have a JD go over or even prepare the contract if you decide to do this.

The American Health Care Lawyers group is great. (Donna Thiel, JD, in DC is

excellent if you want a name; I haven't talked to her in over 6 yrs. though. )

Be sure what the SNF pays you per month includes pay for rehab's non-direct

therapy activites and that it is more than your costs plus a reasonable

profit margin. I know I am stating the obvious but it is astounding how easy it

is

to forget something really important that can cost you a lot because it

wasn't addressed up front. (Ex. If you get a denial, be sure that $$ amount

isn't

deducted from the amount the SNF pays you monthly.)

Have a clause in there that the SNF provides the equipment & rehab supplies

unless you are wealthy and have a garage full of tx equipment & supplies.

Don't forget office supplies, caseload/schedule boards, etc., even paper clips.

Revisit your malpractice/liability insurance and make changes needed to

cover your employees or decide about having independent contractors vs

employees

of yours.

Is this SNF a single bldg. or is it part of a group of SNFs? If the owners

have more, can you have those rehab contracts if you want them later? Can you

refuse one if you can't staff it and it is 250 miles (or etc. )from anywhere

else?

Have the contract address the SNF's responsibility to pay for transport to

and Modified Barium Swallow studies at the hospital for those speech pts. the

SLP may need this diagnostic info on before initiating dysphagia tx.

If you will be the rehab director, put in there that they will pay your

professional dues, send you to your state and national conventions and any

needed CEU activity to renew licensure. You can ask for a rehab dep't. budget

ahead of time.

This list is certainly not inclusive, and I am not a JD and this is not

legal advice. You will want to hire a consultant to help you do this and a JD

to

finalize the proposed contract between you & the SNF. You may be advised to

incorporate or etc. Beckley of Bloomingdale Consulting Group, Inc,

in Tampa is really excellent. I have worked with her before.

You MUST know your cost per minute to do business.

You may also want to have a person certified in healthcare compliance (CCP,

CCE, CHC) look at your contract before you sign it in addition to a JD.

Make haste slowly; avoid what could be very costly mistakes.

Another option that you could suggest if you think this is too much to take

on now is to ask the owners to tell the current contract tx company that

they have now ( or a new one if they aren't happy with the current tx company)

that the owners want you to be the rehab director in their building(s) and

that the tx company should hire you.

Make sure that when the current company is given notice (usually 60 days)

that during those 60 days they should continue to provide appropriate tx

services to the pts. and be sure they don't discharge all of the pts. from

therapies before they leave/stop providing care.

Suggest the owner take an inventory of the current therapy dep't equipment

and supplies now and be sure that keys and computer passwords etc. are all

turned in by the exiting company.

Be professional; do not burn bridges. This is a small industry and you will

find yourself working with some of the current staff somewhere else in future

years.

APTA, AOTA & ASHA all have sections/special interest divisions for

Administration & CLinical Supervision/Private Practice that can give you some

guidance. Go to those websites. ASHA has a handbook on understanding the

Medicare and

other 3rd party reimbursement rules and regs.

Be sure you know who the Fiscal Intermediary is for the SNF (Who does the

billing office send the SNF bills to?) See if they have a LCD for rehab (local

coverage determination). Study it and follow it to the letter. Ask if the

SNF is under 100% medical review or if they are targeted for RAC audit, etc.

Are there any major problems now?Are there many rehab denials? Are those

denials all appealed? Copying charts to appeal denials takes time and a lot of

paper. Will you be able to use the Facility copier? Will they pay for the toner

and paper ? I used to buy toner every two months, for example, but used their

paper and copier and fax. Make sure the contract addresses the long

distance phone charges that may be necessary to obtain authorizations for

continuuing tx from managed care insurers; and to talk with families when

necessary.

Be sure you have and study (again) the Medicare rules & regs and your FI's

guidelines for Medicare Part A and Medicare Part B coverage and your state

Medicaid rules.

Find out what the SNF's last survey results were. Were there any

deficiencies? Were any in rehab? You will have to fix those STAT if they still

exist.

I note that you are a PT. Rick Gawenda, Angie and the owner

of this PT Manager website, are all excellent resources for you. Go to a

seminar of theirs & /or pay them for their consulting time with you one on one.

Good Luck!

Sally -McNamara, MCS, CCC-SLP, CCP

Senior Advisor

The Compliance Resource Group, Inc.

andria, Virginia

In a message dated 12/31/2008 7:38:03 A.M. Eastern Standard Time,

schucmann@... writes:

Hi ..Anybody with knowledge and experience in doing SNF rehab

contract. A SNF administrator and facility CEO is asking me if I want

to get the rehabilitation contract because they are planing to

terminate their current therapy provider. Somebody can PLEASE give

some advise on how to start on getting/doing a SNF contract. I have 8

yrs DOR experiance in a SNF, had work with some therapy contract

company but I am thinking twice about this venture .Thanks

SHELDON,PT

LOS ANGELES,CA

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December 31, 2008