Re: Counting "outside" therapy minutes

[Corey Ali]

Title: Message

More importantly, "therapy minutes" are just that:  Minutes delivered as therapy to improve function, not to facilitate a study.  Furthermore, one of the other responders was correct in whether the MBS itself was a consolidated service under Part A:  = http://www.cms.hhs.gov/medlearn/snfsectionII.asp  (Please note that the periods (. . . .) indicate that not all of the section was copied.  Corey ' Section II. Skilled Nursing Facility Provider and Supplier Coding Files for Claims Submitted on or after January 1, 2003 The following files can be used to determine which services can still be billed separately to your Medicare carrier for services provided to a Medicare beneficiary in a SNF Part A covered stay or a Part B non-covered stay. These files are for payment purposes and do not represent coverage decisions by the agency. All coverage criteria must still be met for services provided to beneficiaries. Though a code for a service may be listed as separately billable to the Medicare carrier on a code list, it will not be paid unless all appropriate coverage criteria are met.  . . . . .   File 4 is only to be used for services rendered to beneficiaries in a Part B non-covered stay. It includes the therapy codes that are subject to SNF consolidated billing for beneficiaries in a Part B non-covered SNF stay. The physician, non-physician practitioner, or supplier must look to the SNF for payment of these services. The Medicare carrier will not pay these services. . . . . .   Coding File 4 – This file has been updated to add new therapy services that must be consolidated and may not be paid separately by the carrier for beneficiaries in a non-covered Part B skilled nursing facility stay. (These services are also not separately payable for beneficiaries in a Part A covered stay and will, therefore, not appear as payable services in Files 1, 2 or 3.) . . . . Therapy . . . . .   92610 – Evaluation of oral and pharyngeal swallowing function – Code effective 1/01/2003 ----- Original Message ----- From: Jane Craven To: [EMAIL PROTECTED] Sent: Wednesday, December 17, 2003 4:47 PM Subject: RE: Counting "outside" therapy minutes Consolidated Billing for the SNF stay doesn’t include uncareplanned/unanticipated procedures/events.   Jane Craven, RN, C. Sr. Consultant, Nursing Services Tendercare (Michigan) Inc.   -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of David Norsworthy Sent: Wednesday, December 17, 2003 4:30 PM To: [EMAIL PROTECTED] Subject: RE: Counting "outside" therapy minutes   It is my understanding that Modified Barium Swallow Studies came under consolidated billing 01/01/03. So the SNF should always be responsible for the bill.   Thanks, David       -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of Nathan Lake Sent: Wednesday, December 17, 2003 3:05 PM To: '[EMAIL PROTECTED]' Subject: RE: Counting "outside" therapy minutes   While I am not certain of the answer to this question (RAI manual not withstanding), I would like to know who paid for the Barium swallow? If the hospital billed Medicare under Part B, and you count those minutes on the MDS for Part A, that seems like a form of double dipping to me. That situation would be particularly ripe for abuse if the nursing home were hospital owned.   Did your facility pay for the test?   Nathan -----Original Message----- From: Jane Craven [mailto:[EMAIL PROTECTED] Sent: Wednesday, December 17, 2003 3:56 PM To: [EMAIL PROTECTED] Subject: RE: Counting "outside" therapy minutes You are correct.  The resident was in a Medicare A stay at the time of the Barium Swallow.  If the resident had received the Barium Swallow prior to coming to the SNF, the minutes would not have counted.   Jane Craven, RN, C. Sr. Consultant, Nursing Services Tendercare (Michigan) Inc.   -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of [EMAIL PROTECTED] Sent: Wednesday, December 17, 2003 3:38 PM To: [EMAIL PROTECTED] Subject: Re: Counting "outside" therapy minutes   This is incorrect.  All therapy minutes delivered after admission to the SNF may be included as long as they were ordered by a physician, performed by a qualified therapist, and were medically necessary.  According to page 3-185 of the RAI User's Manual, "The therapy treatment may occur either inside or outside the facility." Rena Rena R. Shephard, MHA, RN, FACDONA, RAC-C Chair, American Association of Nurse Assessment Coordinators [EMAIL PROTECTED] Subj: RE: Counting "outside" therapy minutes Date: 12/17/03 12:25:18 PM Pacific Standard Time From: [EMAIL PROTECTED] Reply-to: [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent from the Internet No.  No therapy minutes from the hospital stay may be used.  This is in the PPS Final Rules; look on page 41661 of the July 30, 1999 Federal Register-line 12 of the 1st column on this page begins:  "In addition to the issues discussed...".  You will note the eval of the resident's need for therapy must begin in the SNF not in the hospital.   Jane Craven, RN, C. Sr. Consultant, Nursing Services Tendercare (Michigan) Inc.   -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Holly Sox, RN, RAC-C Sent: Wednesday, December 17, 2003 11:15 AM To: [EMAIL PROTECTED] Subject: Counting "outside" therapy minutes   Hi Group, I have a question to relay from an email-impaired friend.   When a Med A resident is sent out to the hospital for modified barium swallow, and returns with documentation of the minutes provided by the SLP doing the study, can these minutes be counted on the MDS?   Thanks!   Holly F. Sox, RN, RAC-C Clinical Editor www.careplans.com   [EMAIL PROTECTED]