RE: Therapy

[Winona M. Phelps]

Hi Lisa.  First of all, there is no such Medicare "rule" that a patient cannot go to a higher level of functioning than they were before.  The question would be "why" was this person functioning at that level?  Did they have pain?  SOB?  A correctable physical limitation?  Depression?  -----the list goes on---- Not knowing this person, I would only guess that perhaps the heart problems plus the wound with infection deteriorated their function/energy to the point where the w/c became the only option for them.  In such a case, correcting the underlying medical conditions could allow this person to regain function and strength to the point to where they could once again be mobile. As far as therapy is concerned, what are the goals that have been established?  Is this person continuing to make progress toward those goals?  Is this reasonable and necessary and in accordance with usual medical practices?  Can it be supported in the documentation?  Is intervention by licensed professionals being done according to practice standards and is it under a treatment plan ordered and supported by physicians' orders?  Is there a reasonable expectation that the patient can and will make gains under the treatment protocol? For your reference, here is the link to the Medicare Program Integrity Manual: http://www.cms.hhs.gov/manuals/108_pim/pim83toc.asp  Hope this is helpful, Winona Phelps, RN   -----Original Message----- From: Lisa Pippin [mailto:[EMAIL PROTECTED] Sent: Wednesday, April 14, 2004 7:53 AM To: [EMAIL PROTECTED] Subject: Therapy I have a question for the group that has not gone to NJ. We have a pt that was living at home and was w/c bound did not ambulate we have the pt on our unit for S/P CABG, dialysis, wound inf with dressing changes and IV antibiotics, along with PT, OT.  We have this person to a higher functioning level than what she was a home she is now walking 120 ft with rolling walker. And therapy says they have to DC because according to Medicare they cannot see the pt anymore because she is at a higher level, than her previous level. Does anyone have any knowledge on this subject? Thanks Lisa Pippin RN Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient and may contain confidential and privileged information. Any unauthorized review, use, disclosure, or distribution is prohibited. If you are not the intended recipient, please contact Lisa Pippin by reply e-mail and destroy all copies of the original message. Shannon Medical Center