You are welcome.
I've quoted the information that was omitted from my previous message.
What's provided is only a brief snippet of regulations that may apply to
your situation. Please feel free to ask any questions that you may have
about private practice. Besides myself, I don't know how many therapists
on the list are in PP, but I will help you all that I can and I hope
others will do the same. I know that other have lots of experience and
knowledge!
Ron C.
{========= Quoted Message From Medicare Follows ========}
On4/20/2005, <name removed by request> said:
> Mr. Carson, I have copied the section from the OT policy regarding
> ADL's.
> Activities of Daily Living
> The following services are generally included in ADL
> training/retraining when used in conjunction with other occupational
> therapy procedures by or under the supervision of licensed personnel.
> Feeding, eating, drinking
> Feeding evaluations and therapy without other forms of active therapy
> require documentation for medical necessity. Medical necessity for
> feeding evaluations may be shown if the record supports a newly
> documented loss of function which is accompanied by weight loss and/or
> muscle wasting. Feeding programs in a skilled nursing home are not
> covered for residents who have not had a documented change in their
> diagnosis or functional status. Therapeutic feeding programs should
> follow the completion of an extensive evaluation by the physician. The
> treatment of dysphagia may include simple recommendations for such
> things as intake consistency or positioning, or may require a
> therapeutic regime targeted at the attainment of functional
> improvement. Please see Florida Part A policy ADYSPHRT
> Dysphagia/Swallowing Diagnosis and Therapy for further indications and
> limitations of coverage and/or medical necessity. Visits for feeding
> programs should be completed within 4 weeks at a decreasing frequency
> of visits. Daily visits for more than one week are not reasonable
> without supporting documentation for continued therapy.
> Bathing, Dressing, Performing Personal Hygiene, Grooming
> Bathing, dressing and personal hygiene training should be part of an
> active treatment plan. Where the therapist is actually performing the
> function(s) of bathing, dressing, grooming or personal hygiene, the
> services are non-covered. Visits for bathing, dressing and personal
> hygiene are not covered for patients in a skilled nursing home unless
> there is adequate documentation to support a newly diagnosed condition
> or change in their functional status which requires the skills of an
> occupational therapist.
> Toileting
> Toileting techniques may be covered as part of an active occupational
> therapy plan of care aimed at restoring a newly lost function. The
> teaching of toileting techniques (balance, clothing management,
> hygiene, assessment of the need for adaptive/assistive equipment) to a
> skilled nursing home patient may only be covered if there is a newly
> diagnosed condition or change in their functional status which
> necessitates training; such as, a new CVA, fractured hip, or
> exacerbation of a known condition such as, multiple sclerosis or
> Parkinson's disease. Frequent visits (daily and/or several times a
> day) or daily visits for a period longer than one week must be
> documented and medically justified.
>
> Advanced ADL Training
> Advanced ADL training involves treatment that will progress the
> patient to the maximum functional independence (i.e., meal
> preparation, household maintenance, etc.). These skills may be covered
> if the patient has the ability to restore these functions and was
> previously at this higher level of function prior to their recent
> illness or injury. Teaching of these skills may require a more lengthy
> course of treatment which would be adequately documented in the
> medical record.
> Community/Work Reintegration Training (CPT Code 97537)
> Community reintegration is performed in conjunction with other
> therapeutic procedures such as gait training and selfcare/home
> management training. The payment for community reintegration training
> is bundled into the payment for those other services. Therefore, these
> services are not separately reimbursable by Medicare. Services which
> are related solely to specific employment opportunities, work skills,
> or work settings are not reasonable and necessary for the diagnosis
> and treatment of an illness or injury and are excluded from coverage
> by section 1862(a)(1) of the Social Security Act.
===========> Original Message Follows ....
On4/20/2005, Amy Schnacker, <[EMAIL PROTECTED]> said:
> Ron- I want to say thanks for all your hard work with this website.... I
> have really enjoyed all the reading. I have not posted much info at
> this point as I am currently working in the schools and just decided to
> start my own practice using hippotherapy part time initially to progress
> to full time. I have a lot of questions for those of you in private
> practice as I have no experienve in this avenue I am jumping into. I
> would love to receive the document from Medicare. Thanks so much!
> Amy Schnacker, OTR/L in Nebraska.
> Ron Carson wrote:
--
Unsubscribe?
[EMAIL PROTECTED]
Change options?
www.otnow.com/mailman/options/otlist_otnow.com
Archive?
www.mail-archive.com/[email protected]
Help?
[EMAIL PROTECTED]
