Home Care Therapy : Quality, Documentation and Reimbursement - A Handbook for Physical Therapists, Speech-Language Pathologists, and Occupational Therapists

by Tina M. Marrelli; Linda H. Krulish

• ISBN13: 9780964780125
• ISBN10: 0964780127
• Format: Paperback
• Copyright: 1999-06-01
• Publisher: Marrelli & Associates, Inc.

Table of Contents

Acknowledgements	p. iii
Reviewers	p. iv
Preface	p. vi
Guidelines for Use	p. xiii
About the Authors	p. xviii
Home Care: An Introduction	p. 1
Home Care: A Working Definition	p. 1
The Big Picture: Four Domains	p. 3
The Reimbursement and Payer Domain	p. 5
Medicare: An Update	p. 5
Home Health Care: Last Vestige of Cost-Based Reimbursement	p. 6
OASIS: Home Care's Newest Regulatory Requirement	p. 7
Medicare: Undergoing Significant Change	p. 8
Medicare Part A	p. 9
Medicare Part B	p. 11
Medicare Changes Pursuant to the BBA of 1997	p. 11
Medicare Risk Health Maintenance Organization (HMO) Programs	p. 13
Compliance: Everyone's Role	p. 13
Strategies for Organizations to Ensure Ongoing Compliance	p. 13
Documentation to Support Covered Care	p. 14
Medicare Requirements for Home Care	p. 15
Homebound: A Major Qualifying Criteria	p. 15
Homebound: Patient Example - Mrs. Smith	p. 16
Roles of Effective Documentation	p. 18
Documentation: An Overview	p. 19
The Important Role of Documentation: A Checklist Approach	p. 20
The Care Process: Assessment and Documentation	p. 21
The Care Process: Intervention and Documentation	p. 21
Documentation Problems: Common Reasons for Payment Denials	p. 22
General Medical Review Problems (or What to Avoid)	p. 23
Specific Therapy Problems	p. 23
Summary	p. 24
The Customer Service and Quality Imperatives	p. 25
Quality 101: An Overview	p. 26
Competency Assessment: Foundation for Excellence	p. 26
Data Management: Increasing Focus	p. 32
Customer Service	p. 33
Who is the Customer?	p. 35
Summary	p. 36
The Patient's Environment of Care: Home (Or the Reason Home Care is So Unique)	p. 37
Patient Example: The Setting Negatively Impacting Care Goals	p. 37
Environmental Safety Considerations: Identifying At-Risk Patients	p. 39
Medical Social Services: Important Role	p. 40
Services of the Medical Social Worker	p. 41
Summary	p. 42
Patient Care Planning and Related Processes	p. 43
Skilled Therapy: The Basic Rules	p. 43
Coverage Versus Scope of Practice Dilemma	p. 45
Physical Therapy Services in Home Care	p. 45
Speech-Language Pathology Services in Home Care	p. 46
Dietitian Services in Home Care	p. 50
Occupational Therapy Services in Home Care	p. 50
Occupational Therapy Coverage: Special Considerations	p. 50
The Role of the Therapist as Case Manager	p. 56
Sources of Data Needed for Holistic Case Management	p. 56
"Therapy Only" Case Considerations	p. 57
Patient Example: Identifying Other Patient Needs	p. 57
Medicare Skilled Nursing Services	p. 58
Managing the Patient's Care: The Care Process	p. 59
11 Patient-Directed Roles of the Effective Case Manager	p. 64
The Case Manager's Role as Supervisor and Educator	p. 65
Home Health Aide Services: Making the Difference for Patients	p. 65
Medicare and Home Health Aide Services	p. 66
Home Health Aide Supervisory Visits: The Law	p. 67
Other Supervisory Activities	p. 67
Team Communications and Care Coordination: Keys to Success	p. 69
Examples of Effective Care Coordination	p. 69
Summary	p. 70
Specialty Therapy Practices	p. 71
Pediatries and Therapy: Making A Difference in Young Lives	p. 71
Children Seen in Home Care Therapy Practice	p. 71
ICD-9 Codes for Pediatric Therapy	p. 71
Infection Control and Safety in Children: The Drool Factor	p. 73
Children are Different: 12 Tips for Success	p. 73
Summary	p. 84
Home Hospice Care and the Therapist: Efforts Directed Toward Comfort and Safety	p. 85
Hospice Care: An Introduction	p. 85
Why (or Why Not) Hospice	p. 86
Mr. Walker - A Patient Example	p. 87
Differences: A Review of the Intents of the Programs and Definitions	p. 89
Similarities in the Intersection of the Two Spheres	p. 89
For Both Programs the Quality and Customer Services Imperatives	p. 92
Palliative Care	p. 93
Therapy Coverage and Care Planning Considerations: A Case Study	p. 93
Documentation Problems to Avoid	p. 95
Summary	p. 95
The Rehabilitation Team: The Big Picture	p. 96
Practice Standards, Guidelines, and Considerations for PT, SLP and OT from the National Professional Associations	p. 96
Physical Therapy Services	p. 96
Speech-Language Pathology Services	p. 123
Occupational Therapy Services	p. 136
Assessment: The Process	p. 154
Referral	p. 154
Scheduling the Assessment	p. 155
The Assessment Visit	p. 155
"Therapy-Only" Case Admissions: Operational Challenge	p. 162
The HCFA Form 485	p. 163
Completing The HCFA Form 485 - A Patient Example: Mrs. Nicholas	p. 169
Assessment Findings	p. 169
Changes to the Conditions of Participation: Impact on the Home Care Admission	p. 170
Patient Outcomes	p. 172
The Comprehensive Assessment: Identifying Patient Needs and Facilitating Outcomes Measurement	p. 174
The Initial Assessment Visit: Timely Initiation of Services	p. 174
Completion of the Comprehensive Assessment	p. 176
The Drug Regimen Review: Models for Meeting Regulatory Intent	p. 176
Updates to the Comprehensive Assessment: Ongoing Assessment and Data Collection	p. 177
Summary	p. 178
OASIS: Quality, Reimbursement, and Documentation Considerations With Sample Forms	p. 179
Outcome-Based Quality Improvement: The Big Picture	p. 179
OASIS: Linking Quality and Reimbursement	p. 180
OASIS: The Newest Documentation and Quality Requirement	p. 180
Rules for OASIS Data Collection	p. 181
Documenting the Comprehensive Assessment and OASIS Data Collection - Patient Example Revisited	p. 189
Intent of OASIS Data Collection	p. 205
Competency Assessment: Key to Success for OASIS	p. 206
Summary	p. 214
Therapy Care Guides: Focus on Function	p. 215
General Care Guide Summary	p. 217
Specific Functional Care Guides	p. 224
Ambulation	p. 224
Bathing-Tub/Shower Transfers	p. 227
Bed Mobility	p. 230
Car Transfers	p. 233
Dressing	p. 236
Eating/Self-Feeding	p. 239
Emergency Response Needs	p. 242
Functional Communication	p. 245
Grooming	p. 248
Homemaking	p. 251
Kitchen Functioning	p. 255
Laundry	p. 258
Medication Management	p. 261
Money Management	p. 264
Pain Management	p. 267
Toileting	p. 270
Transfers	p. 273
Wheelchair Function	p. 277
Optimizing Home Safety	p. 281
Equipment Considerations: Assistive and Adaptive Devices	p. 281
Gait Considerations	p. 281
Bathroom Equipment	p. 283
Equipment for Self-Care	p. 285
Wheelchair Assessment	p. 288
A Home Safety Program: Guidelines and Assessment	p. 291
Human Resource Management	p. 294
Competence Assessment	p. 294
Scope of Competency Program	p. 297
Physical Therapist Competence Review/Evaluation Form	p. 299
Speech-Language Pathologist Competence Review/Evaluation Form	p. 301
Occupational Therapist Competence Review/Evaluation Form	p. 303
Job Description Examples	p. 305
Medicare Home Health Agency Manual (HCFA Pub.-11)	p. 312
Coverage of Services for Skilled Therapy	p. 312
Completion of the Plan of Care (HCFA Form 485)	p. 319
Resources	p. 348
Abbreviation List	p. 348
Glossary of Terms	p. 354
State Licensing Information	p. 382
Directory of Resources	p. 393
OASIS (B-1)	p. 416
Federal Register: Mandatory Use, Collection, Encoding, and Transmission of Outcomes and Assessment Information Set (OASIS) for Home Health Agencies	p. 435
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