Understanding Medicare MDS 3.0 for the Rehabilitation Professional 2nd edition

Course Content

Total learning: 2 lessons / 1 quiz Time: 52 weeks

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