Understanding Medicare MDS 3.0 for the Rehabilitation Professional 2nd edition
Understanding Medicare MDS 3.0 for the Rehabilitation Professional 2nd edition , Course Content
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