OK GANG, I stand corrected!!!! I had worked on
explanation of Section T for AANAC many years ago and still had all of my text
on disks. I found the language that references needing to count minutes
provided up to the ARD date in Section T. in an appendix I created. The
reference in the Appendix was www.hcfa.gov/medicare/hsqb/mds20/res_man.htm.
However when I tried to retrieve using CMS rather then HCFA, I was unable to
find. I am attaching the language referencing this issue and I appologize to the
group for my mistake. Thank goodness I never throw out anything! I am sooooo
sorry!!!
Gail Neustadt, NHA
----- Original Message -----
Sent: Monday, April 12, 2004 12:29
PM
Subject: Re: therapy minutes
Thanks, this is not my understanding, but things
may have changed so I may be incorrect.
It was my understanding that the purpose of
Section T when it was originally conceived of was to protect the facility from
those times when a resident who was thought to be a good rehab candidate at
the time of the therapy evaluations and POCs did not meet original
expectations. So for instance, lets say that a resident with a recent CVA
who was receiving aggressive therapy in the hospital, was admitted to the SNF,
evaluated by the Therapists and thought to be able to tolerate 60 min.
per day from each discipline. If this were to happen, Section P would
calculate the resident to be an UH. The therapists complete Section T
estimating 10 days of 3 disciplines for a total of with 9000 minutes. If
the resident then becomes ill on day four and therapy is discontinued,
the resident will have only received 240 minutes. If Section T was completed
with the original projection, the resident would RUG at RH rather than
RM. If I am not understanding this correctly, or if I have
missed a CMS Transmittal re-clarifying how to document Saction T and its
purpose, please send me the reference. Thanks in advance.
Gail Neustadt
----- Original Message -----
Sent: Monday, April 12, 2004 8:41
AM
Subject: RE: therapy minutes
Gail.
Section T is a combination of actual minutes provided up to the ARD
as well as a projection of what additionally will be provided up to
day 15. You do include the actual minutes provided from Section P in
your projection in Section T.
Ron
Hi Rena,
Thanks for your comments and reference. Could
you also comment re theestimate of the minutes being just that an
estimate, prior to actual minutes being provided? Thanks in
advance.
Gail
----- Original Message -----
Sent: Saturday, April 10, 2004 5:24
PM
Subject: Re: therapy minutes
It's not surprising that folks are not
certain of the answer to this question, because it has been answered a
couple of different ways in recent years. However, the regulation
is - if you know coming in the door that the resident will be leaving
prior to day 15, then you must enter the number of days the resident is
expected to be in the facility and receiving the services.
It is
the following section of the PPS Final Rule (July 30, 1999, page 41662)
that is at the center of this answer:
If the physician orders
therapy for 10
days, the projected number of days in
section T
will be 10 rather than 14;
likewise, if the physician does not
order
a limited number of days, the projection
will be based on
the entire two weeks,
assuming the beneficiary's continued
stay
and receipt of services.
The RAI User's Manual clears up the
question of what to do if the resident is expected to stay for at least
15 days but leaves early:
"Calculate the expected number of days
through day 15, even if the resident is discharged prior to day 15." and
"Calculate the expected number of minutes through day 15, even if the
resident is discharged prior to day 15. (p. 3-216)." In that case,
of course, you would bill only for the number of days the resident was
actually in the facility and receiving the
services.
Rena
Rena R. Shephard, MHA, RN, FACDONA,
RAC-C
Chair, American Association of Nurse Assessment
Coordinators
[EMAIL PROTECTED]
Subj: therapy minutes
Date: 4/10/04 5:56:12 AM
Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the
Internet
I work at the SNF unit of a hospital, and
most of our patients are high level.When PT and OT evaluate these
patients, usually the estimated duration of therapy is 5-7 days
only,then they're discharged home. Therapy orders are usually written
PT and OT daily for 7 days. My question is filling out the section T
of the MDS,in the estimated number of days and minutes. If the patient
is discharged after the 7th day therapy was rendered, should I enter 7
days as the estimate number of days, and the total minutes rendered on
the estimate number of minutes? Or should I calculate the estimated
number of days and minutes through day 15 eventhough i know from the
start that this patient will only stay here after 7 days of
therapy?
i.e....April 1 - date of
admission
2 - PT/OT eval and tx day
1 = total min. for both = 60min
3 -
day 2 of
therapy
45min
4 - " 3
"
45min
5 - " 4
"
45min
6 - " 5
"
45min
7 - " 6
"
45min
8 - " 7
"
30min
9 - dc
home
The total therapy minutes
for example is only 315 min. In section T, should I write 7 days and
315 min? Or estimate until day 15 eventhough I know that the patient
will be
discharged?
Thanks...
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in the case of a Medicare 5 day assessment.doc