Understanding Medicare MDS 3.0 for the Rehabilitation Professional 2nd edition

Chapter One: Introduction

• Medicare; Medicare Part A; Medicare Part B; Medicaid
• Advance Beneficiary Notice
• Medicare Recovery Audit Contractor
• Medicare Administrative Contractors
• Medicare Skilled Guidelines; Medical Necessity
• Expressing Medical Necessity and Skilled Care

Chapter Two: Maintenance Programs

• Evaluation and Maintenance Plan without Rehabilitative Treatment
• Skilled Maintenance Therapy for Safety
• Individual Activities Concurrent with Rehabilitative Treatment
• Evaluation and Maintenance Program without Rehabilitation Therapy
• Maintenance Therapy Lawsuit

Chapter Three: Medicare Appeal Deadlines

• Appealing Recoupment
• Sample Letters of Appeal
• Denial Letter for Unanticipated Discharge
• Denial Letter which Requires Functional Goals
• Program Safeguard Contractor Audits

Chapter Four: Effective Documentation

• Late Entries and Supplemental Notes; Documentation Requirements
• Documentation Required; Limits on Requirements;
• Certifications and Recertifications; Dictated Documentation
• Dates for Documentation
• Evaluation/Re-Evaluation and Plan of Care
• When the Evaluation Serves as the Plan of Care
• Re-Evaluations; Progress Reports; Absences; Delayed Reports; Early Reports
• Progress Reports for Services Billed Incident to a Physician’s Service
• Documenting Clinician Participation in Treatment in the Progress Report
• Assistant’s Participation in the Progress Report
• Content of Clinician Progress Reports
• Objective Evidence; Discharge Notes; Treatment Notes; Describing Pain
• Justification for Skilled Services; Risk Factors
• Documenting a Patient’s Potential for Rehabilitation
• Creating Goals; Plan of Care; Treatment under a Plan; Two Plans; Contents of Plan
• Changes to the Therapy Plan

Chapter Five: Functional Status Guidelines

• Instructions for Rule of 3
• Detailed Coding Instructions for G0110 Column 1 ADL Self-Performance
• Functional Rehabilitation Potential

Chapter Six: CPT Codes

• Untimed CPT Codes; Timed CPT Codes
• Utilization Guidelines and Maximum Billable Units per Date of Service
• 0183T: Low Frequency, Non-Contact, Non-Thermal Ultrasound (MIST Therapy)
• 29065: Application of Casts and Strapping Codes
• G0283: Electrical Stimulation (CPT G0283 or 97032)
• 90911: Biofeedback Therapy
• 95851: Range of Motion Tests
• 96125: Standardized Cognitive Performance Testing
• 97001: Physical Therapy Evaluation
• 97002: Physical Therapy Re-Evaluation
• 97003: Occupational Therapy Evaluation
• 97004: Occupational Therapy Re-Evaluation
• 97010: Hot/Cold Packs
• 97012: Traction, Mechanical (to one or more areas)
• 97016: Vasopneumatic Devices (to one or more areas)
• 97018: Hot Wax/ Paraffin Treatment
• 97022: Whirlpool
• 97024: Diathermy (i.e. microwave)
• 97026: Infrared Therapy
• 97028: Ultraviolet (to one or more areas)
• 97033: Iontophoresis
• 97034: Contrast Baths (to one or more areas)
• 97035: Ultrasound (to one or more areas)
• 97036: Hubbard Tank (to one or more areas)
• 97110: Therapeutic Exercises
• 97112: Neuromuscular Re-education
• 97113: Aquatic Therapy with Therapeutic Exercise
• 97116: Gait Training
• 97124: Massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion) (one or more areas, each 15 minutes)
• 97140: Manual Therapy
• 97150: Group Therapy Services
• 97545: Work Hardening (97545, 97546)
• 97530: Therapeutic Activities
• 97532: Development Of Cognitive Skills To Improve Attention, Memory, Problem Solving, (includes compensatory training) direct (one on one) patient contact by the provider, each 15 minutes
• 97535: Self–Care/Home Management Training
• 97537: Community/Work Reintegration Training
• 97542: Wheelchair Management
• 97597: Selective Debridement
• 97605: Negative Pressure Wound Therapy
• 97750: Physical Performance Testing
• 97755: Assistive Technology
• 97760: Orthotic Management & Training
• 97761: Prosthetic Training, upper and/or lower extremity(s), each 15 minutes
• 97762: Checkout For Orthotic/Prosthetic Use, established patient, each 15 minutes
• 97799: Unlisted Physical Medicine/Rehabilitation Service Or Procedure, not timed (97799, 97139 or 97039)
• Miscellaneous Services (Non-covered)

Chapter Seven: Reporting of Service Units

• Timed and Untimed Codes
• Counting Minutes for Timed Codes in 15-Minute Units
• Group Therapy
• Concurrent Therapy (also known as Dovetailing)
• Student Supervision
• Billing Scenarios Part A vs. Part B
• CPT Codes Clarification
• Therapy Certifications
• Initial Certification
• Timing of Initial Certification
• Review of Plan and Recertification
• Physician/Non-physician Practitioner Options for Certification
• Restrictions on Certification
• Delayed Certification
• Denials Due to Certification
• Exceptions for Medically Necessary Services
• Appeals Related to Disapproval of Cap Exceptions
• Appeals
• Application of New Coding Requirements
• Services Affected
• Providers and Practitioners Affected

Chapter Eight: Functional Limitation Reporting Under Medicare Part B

• Function-related G-codes
• Mobility G-code Set
• Changing & Maintaining Body Position G-code set:
• Carrying, Moving & Handling Objects G-code Set
• Self-Care G-code Set
• Other PT/OT Primary G-code Set:
• Other PT/OT Subsequent G-code Set:
• Swallowing G-code Set:
• Motor Speech G-code Set:
• Spoken Language Comprehension G-code Set:
• Spoken Language Expressive G-code Set:
• Attention G-code Set:
• Memory G-code Set:
• Voice G-code Set:
• Other Speech-language Pathology G-code Set:

Chapter Nine: G-Codes Clarification

• Required Tracking and Documentation of Functional G-codes and Severity Modifiers
• Remittance Advice Messages
• General Information on the Therapy Cap
• Multiple Procedure Payment Reduction (MPPR)
• 2013 Therapy Cap Limitations
• 2013 Medicare Copays and Deductibles
• Therapy Cap Exceptions Process
• Coding Guidelines

Chapter Ten: Major RUG-IV Category

• Major RUG-IV Category
• Ultra High Rehabilitation Plus Extensive Services
• Very High Rehabilitation Plus Extensive Services
• High Rehabilitation Plus Extensive Services
• Medium Rehabilitation Plus Extensive Services
• Low Rehabilitation Plus Extensive Services
• Ultra High Rehabilitation
• Very High Rehabilitation
• High Rehabilitation
• Medium Rehabilitation
• Low Rehabilitation
• Guidelines
• Characteristics Associated With Major RUG-IV Category
• Medicare Short Stay Assessment
• Technical Eligibility Requirements
• Clinical Eligibility Requirements
• Calculation of Total Rehabilitation Therapy Minutes
• Three-Day Policy
• Change of Therapy (COT) and Other Medicare Required Assessment (OMRA)
• Leave of Absence
• Delay in Requiring and Receiving Skilled Services (30-Day Transfer)
• Medical Appropriateness Exception (Deferred Treatment)
• ARD outside the Medicare Part A SNF Benefit
• Distinct Calendar Days of Therapy

Chapter Eleven: Clarifications

• Clarification regarding early assessment penalty policy
• Clarification regarding the relationship between the Change of Therapy OMRA and the Day of Discharge
• Clarification regarding the beginning of a COT observation period
• Clarification regarding completion of interview items on COT OMRA
• Clarification regarding when a COT evaluation should be completed
• Clarification regarding requirements for completing an EOT OMRA
• Clarification regarding how to bill an End-of-Therapy OMRA reporting Resumption
• Clarification regarding the definition of a resumption of therapy

Chapter Twelve: Using ICD-9 Codes and ICD-10 Codes

• Basic Guidelines in Using ICD-9 codes
• Transitioning to the ICD-10 Codes

Chapter Thirteen: Administrative Matters

• Top 8 Ways to Build Medicare Part B Programming
• Common Billing Errors and How to Avoid Them
• Staffing
• Restorative Nursing Program
• Restorative Nursing Assistant/ Rehabilitation Nursing Assistant (RNA)
• Restraints and Safety

Chapter Fourteen: Legal Issues

• Elder Abuse; Incident Reports; Medical Equipment
• Refusing to Care for a Resident; Unanticipated Outcomes
• Noncompliant Residents; Bending the rules
• Supervising Assistive Personnel
• Infection Control; Resident Privacy; Legal Foundations; Ethical Foundations
• The Law of HealthCare Malpractice
• Intentional Wrongs; Employment; Business Law & Ethics
• Legal and Ethical Issues in Education; Ethics in Focus