Hello All: Glad to see some messages!!!
The below messages bring up a question that I've always pondered. Does Medicare pay for WHAT we do (i.e CPT codes)or WHY we do them (i.e. goals)? Ron ----- Original Message ----- From: Jim Arceneaux <[EMAIL PROTECTED]> Sent: Sunday, January 07, 2007 To: [email protected] <[email protected]> Subj: [OTlist] OTs place in the system JA> Hi Gina, JA> I am familiar with what you are describing in an inpatient JA> rehab. setting. I would like to comment on one part of your JA> message in particular. We have discussed insurance not paying for JA> leisure before. This is true in a sense, but speaking as someone JA> that has reviewed Medicare claims for documentation of medical JA> necessity, it does not tell the whole story. If an OT writes in JA> their note that "today the patient was engaged in Bingo," yes the JA> claim will be denied (if reviewed). The key is to document what JA> you were working on specifically. What performance components (to JA> use practice framework terminology) were you addressing. In the JA> same scenario above if you stated you provided a therapeutic JA> activity with lets say visual cues for scanning strategies in a JA> patient with left neglect, magically you would be paid. The truth JA> is that the bingo isn't the skilled (or payable) service. Its JA> what an OT does to manipulate the activity (grading, etc.) that is JA> skilled. It is not JA> unethical to document in the manner above as it is truthful JA> to what was done. OT does not just play bingo with patients. We JA> don't go paly golf or help a patient play golf. We do however JA> remediate a patient's ability to engage in activities they enjoy. JA> Jimmie JA> [EMAIL PROTECTED] wrote: JA> Hello All, JA> After reading many of the posts on OTs purpose and function. I noticed JA> some things were not mentioned. One being that in most Reahb hospitals OT JA> is slotted to provide 1.5 hours per day and for many pateints functional JA> issues can be addressed more quickly and effieciently and then that leaves JA> a lot of itme available that has to be filled in. For example, after a JA> couple of OT sessions to address dressing equipment, home management, & JA> bathing issues, etc, hip & knee patients need an OT less than they get in JA> Rehab. I think that new students then come away with this idea of OT doing JA> exercise because they have to fill in that time. JA> Also don't forget insurance payors. You start documenting working on JA> leisure skills and they begin to balk. I find that if I really focus on JA> functional issues (and yes I do actually work on leisures skills in JA> conjuction with my treatment for daily living skills) many times I can be JA> out quickly, needing very few treatments or many patients don't want to JA> worry about those issues, preferring to have family cook, etc. So I JA> believe it is a complex problem. I work in home health and do (in home) JA> outpatient OT services and am able to just see patients to address their JA> needs and get out without having to make up things to work on as happens JA> in Rehab & SNF frequently. I have done some PRN work in SNF lately and JA> they did not like my style of treatment as many times after a certain JA> period and goals were met I would try to decrease minutes for the week JA> instead of doing UE exercise to fill in the time. So I do agree that the JA> issue often is about money but it is also about OTs retaining a certain JA> level of hours (workload) either for payments from insurance or to keep JA> their of income at a certain level or lack of patient interest in JA> addressing Daily Living Skills. JA> Out of my home health caseload, I would estimate that about only 25% of my JA> referrals have daily living needs that I can address (or clients want JA> addressed). Frequently one to five visits may take care of any area that JA> need to be addressed. So my caseload is composed of a few clients who I JA> see twice weekly for 9-12 weeks and most who I see one to five visits. JA> While PT can go in and do exercises, etc 3X weekly for 4-9 weeksfor most JA> of their patients. OT generally doesn't need to see as many patients for JA> that length of time. I think sometimes we think quantity more than JA> quality. While I do see many patients who need OT not getting it, I also JA> see patients getting OT services not needed (by that I mean they aren't JA> addressing Daily Living Skills). That means an OTs role may be smaller in JA> quantity compared to other disciplines (but no less important) and many JA> OTs (or facilities) want more time. I realize I am preaching to the choir JA> as most OTs on this lilst understand this or they wouldn't bother to be JA> here. JA> Just my take. JA> Gina Tate JA> -- JA> Options? JA> www.otnow.com/mailman/options/otlist_otnow.com JA> Archive? JA> www.mail-archive.com/[email protected] JA> ************************************************************************************** JA> Enroll in Boston University's post-professional Master of JA> Science for OTs Online. Gain the skills and credentials to propel JA> your career. JA> www.otdegree.com/otn JA> ************************************************************************************** JA> __________________________________________________ JA> Do You Yahoo!? JA> Tired of spam? Yahoo! Mail has the best spam protection around JA> http://mail.yahoo.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] ************************************************************************************** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **************************************************************************************
