RE: Therapy

[Karen Berry]

Title: Message

Medicare guidelines have usually stressed the prior level of function as the ultimate goal. If this person was w/c bound for a long (very subjective) period, the FI may not see continuing therapy as reasonable and necessary. Check with you FI. Why was this person non-ambulatory, and did he/she receive any therapy as an outpatient or in the home? The issue of reasonable and necessary can be sticky. The resident/responsible party can request a demand bill if they do not agree with the facility's determination. And if you do not terminate benefits and the FI denies further services your facility will be out that money. -----Original Message----- From: Lisa Pippin [mailto:[EMAIL PROTECTED] Sent: Wednesday, April 14, 2004 10:53 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