Home Care Therapy: Quality, Documentation and Reimbursement - a Handbook for Physical Therapists, Speech-Language Pathologists, and Occupational Therapists / Edition 1

Home Care Therapy: Quality, Documentation and Reimbursement - a Handbook for Physical Therapists, Speech-Language Pathologists, and Occupational Therapists / Edition 1

by Tina M. Marrelli, Linda H. Krulish

ISBN-10: 0964780127

ISBN-13: 9780964780125

Pub. Date: 06/28/1999

Publisher: Marrelli & Associates, Incorporated

Product Details

Marrelli & Associates, Incorporated
Publication date:
Edition description:
New Edition
Product dimensions:
5.03(w) x 7.00(h) x 1.03(d)

Table of Contents

Guidelines for Usexiii
About the Authorsxviii
Part 1Home Care: An Introduction1
Home Care: A Working Definition1
The Big Picture: Four Domains3
Domain 1The Reimbursement and Payer Domain5
Medicare: An Update5
Home Health Care: Last Vestige of Cost-Based Reimbursement6
OASIS: Home Care's Newest Regulatory Requirement7
Medicare: Undergoing Significant Change8
Medicare Part A9
Medicare Part B11
Medicare Changes Pursuant to the BBA of 199711
Medicare Risk Health Maintenance Organization (HMO) Programs13
Compliance: Everyone's Role13
Strategies for Organizations to Ensure Ongoing Compliance13
Documentation to Support Covered Care14
Medicare Requirements for Home Care15
Homebound: A Major Qualifying Criteria15
Homebound: Patient Example - Mrs. Smith16
Roles of Effective Documentation18
Documentation: An Overview19
The Important Role of Documentation: A Checklist Approach20
The Care Process: Assessment and Documentation21
The Care Process: Intervention and Documentation21
Documentation Problems: Common Reasons for Payment Denials22
General Medical Review Problems (or What to Avoid)23
Specific Therapy Problems23
Domain 2The Customer Service and Quality Imperatives25
Quality 101: An Overview26
Competency Assessment: Foundation for Excellence26
Data Management: Increasing Focus32
Customer Service33
Who is the Customer?35
Domain 3The Patient's Environment of Care: Home (Or the Reason Home Care is So Unique)37
Patient Example: The Setting Negatively Impacting Care Goals37
Environmental Safety Considerations: Identifying At-Risk Patients39
Medical Social Services: Important Role40
Services of the Medical Social Worker41
Domain 4Patient Care Planning and Related Processes43
Skilled Therapy: The Basic Rules43
Coverage Versus Scope of Practice Dilemma45
Physical Therapy Services in Home Care45
Speech-Language Pathology Services in Home Care46
Dietitian Services in Home Care50
Occupational Therapy Services in Home Care50
Occupational Therapy Coverage: Special Considerations50
The Role of the Therapist as Case Manager56
Sources of Data Needed for Holistic Case Management56
"Therapy Only" Case Considerations57
Patient Example: Identifying Other Patient Needs57
Medicare Skilled Nursing Services58
Managing the Patient's Care: The Care Process59
11 Patient-Directed Roles of the Effective Case Manager64
The Case Manager's Role as Supervisor and Educator65
Home Health Aide Services: Making the Difference for Patients65
Medicare and Home Health Aide Services66
Home Health Aide Supervisory Visits: The Law67
Other Supervisory Activities67
Team Communications and Care Coordination: Keys to Success69
Examples of Effective Care Coordination69
Part 2Specialty Therapy Practices71
Pediatries and Therapy: Making A Difference in Young Lives71
Children Seen in Home Care Therapy Practice71
ICD-9 Codes for Pediatric Therapy71
Infection Control and Safety in Children: The Drool Factor73
Children are Different: 12 Tips for Success73
Home Hospice Care and the Therapist: Efforts Directed Toward Comfort and Safety85
Hospice Care: An Introduction85
Why (or Why Not) Hospice86
Mr. Walker - A Patient Example87
Differences: A Review of the Intents of the Programs and Definitions89
Similarities in the Intersection of the Two Spheres89
For Both Programs the Quality and Customer Services Imperatives92
Palliative Care93
Therapy Coverage and Care Planning Considerations: A Case Study93
Documentation Problems to Avoid95
Part 3The Rehabilitation Team: The Big Picture96
Practice Standards, Guidelines, and Considerations for PT, SLP and OT from the National Professional Associations96
Physical Therapy Services96
Speech-Language Pathology Services123
Occupational Therapy Services136
Part 4Assessment: The Process154
Scheduling the Assessment155
The Assessment Visit155
"Therapy-Only" Case Admissions: Operational Challenge162
The HCFA Form 485163
Completing The HCFA Form 485 - A Patient Example: Mrs. Nicholas169
Assessment Findings169
Changes to the Conditions of Participation: Impact on the Home Care Admission170
Patient Outcomes172
The Comprehensive Assessment: Identifying Patient Needs and Facilitating Outcomes Measurement174
The Initial Assessment Visit: Timely Initiation of Services174
Completion of the Comprehensive Assessment176
The Drug Regimen Review: Models for Meeting Regulatory Intent176
Updates to the Comprehensive Assessment: Ongoing Assessment and Data Collection177
Part 5OASIS: Quality, Reimbursement, and Documentation Considerations With Sample Forms179
Outcome-Based Quality Improvement: The Big Picture179
OASIS: Linking Quality and Reimbursement180
OASIS: The Newest Documentation and Quality Requirement180
Rules for OASIS Data Collection181
Documenting the Comprehensive Assessment and OASIS Data Collection - Patient Example Revisited189
Intent of OASIS Data Collection205
Competency Assessment: Key to Success for OASIS206
Part 6Therapy Care Guides: Focus on Function215
General Care Guide Summary217
Specific Functional Care Guides224
Bathing-Tub/Shower Transfers227
Bed Mobility230
Car Transfers233
Emergency Response Needs242
Functional Communication245
Kitchen Functioning255
Medication Management261
Money Management264
Pain Management267
Wheelchair Function277
Part 7Optimizing Home Safety281
Equipment Considerations: Assistive and Adaptive Devices281
Gait Considerations281
Bathroom Equipment283
Equipment for Self-Care285
Wheelchair Assessment288
A Home Safety Program: Guidelines and Assessment291
Part 8Human Resource Management294
Competence Assessment294
Scope of Competency Program297
Physical Therapist Competence Review/Evaluation Form299
Speech-Language Pathologist Competence Review/Evaluation Form301
Occupational Therapist Competence Review/Evaluation Form303
Job Description Examples305
Part 9Medicare Home Health Agency Manual (HCFA Pub.-11)312
Coverage of Services for Skilled Therapy312
Completion of the Plan of Care (HCFA Form 485)319
Part 10Resources348
Abbreviation List348
Glossary of Terms354
State Licensing Information382
Directory of Resources393
Appendix AOASIS (B-1)416
Appendix BFederal Register: Mandatory Use, Collection, Encoding, and Transmission of Outcomes and Assessment Information Set (OASIS) for Home Health Agencies435

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