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Documentation Strategies for Nurses and Therapists January 2, 2007 at 1:00 EST

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Documentation Strategies for Nurses and Therapists January 2, 2007 at 1:00 EST Lisa Bazemore, MBA, MS, CCC-SLP Setting the Stage Why do we document care? – PowerPoint PPT presentation

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Title: Documentation Strategies for Nurses and Therapists January 2, 2007 at 1:00 EST


1
Documentation Strategies for Nurses and
Therapists January 2, 2007 at 100 EST
  • Lisa Bazemore, MBA, MS, CCC-SLP

2
Setting the Stage
  • Why do we document care?
  • To insure payment for the services rendered
  • To insure continuity of care
  • Principles of documentation
  • Document to your audience
  • Focus on deficits
  • Attainable goals
  • Progress towards goals
  • Consider barriers to discharge
  • Consider return to both home and community

3
Setting the Stage
  • What is Medical Necessity?
  • A course of treatment that is seen as most
    helpful for the specific health symptoms that the
    patient is experiencing. This course of
    treatment is determined by the patient and their
    healthcare team.

4
Setting the Stage
  • 7 Criteria of Medical Necessity
  • Medical Supervision
  • 24 Hour Rehab Nursing
  • Relatively Intense Level of Services
  • Multidisciplinary Approach
  • Coordinated Care Plan
  • Significant Practical Improvement
  • Realistic Goals

5
Components of Medical Necessity
  • Close Medical Supervision
  • 24 hour availability of a physician
  • Entries in the chart every 2 -3 days minimum
  • Greater involvement that in other settings

6
Components of Medical Necessity
  • 24 Hour Rehabilitation Nursing
  • Need availability of an RN with rehab experience
    around the clock
  • Have clear, functional rehabilitation goals
  • Nursing is involved in the overall plan of care,
    not just medical issues and bowel and bladder
    management
  • Nursing documentation supports FIM scores
  • Nursing documentation clearly identifies how they
    facilitate the carryover of learning from therapy
    sessions
  • Nursing documentation supports the medical
    management of the patient

7
Components of Medical Necessity
  • Relatively Intense Level of Rehabilitation
    Services
  • The 3 Hour Rule
  • Minimum of 3 hours of therapy, 5 days per week
  • Therapy is at a skilled level
  • Must be necessary for meeting the basic needs of
    the patients health
  • Must be consistent in type, frequency, and
    duration
  • Consistent with the patients diagnosis

8
Components of Medical Necessity
  • Interdisciplinary Approach
  • Members work collaboratively to develop goals and
    the treatment plan
  • Team members engage and learn from each other
  • Collaborative ownership of the patient treatment
    plan

9
Components of Medical Necessity
  • Coordinated Plan of Care
  • Records need to show a treatment plan that is
  • Derived from team assessment and patient
    expectations
  • Identifies STGs and LTGs
  • Defines how disciplines share responsibility
  • Supports need for intensive rehab services
  • Weekly team conference

10
Components of Medical Necessity
  • Significant Practical Improvement
  • We do not expect 100 independence for all rehab
    patients
  • We do expect reasonable, practical improvement
  • Improvement must be the result of skilled
    services provided
  • Important that it is documented clearly

11
Components of Medical Necessity
  • Realistic Goals
  • Aim of treatment needs to be achieving the
    maximum level of function possible

12
How Do We Document Medical Necessity?
  • Team has an ongoing opportunity to document
    medical necessity. This is achieved by
    documenting
  • That services needed are of a complex nature that
    they require a licensed clinician
  • Services need to be in an inpatient setting
  • Services are consistent with diagnosis, need, and
    medical condition
  • Services are consistent with the treatment plan
  • Services are reasonable and necessary
  • Patient is making progress towards reasonable
    goals

13
Where Do We Document Medical Necessity?
  • Pre-admission Screening
  • Team Admission Assessments
  • Nursing Admission Assessments
  • Patient Care Plan
  • Long term goals
  • Short term goals
  • Identification of involved disciplines
  • Weekly progress notes
  • Discharge summaries
  • Team Conference Summaries

14
Preadmission Screening
  • Diagnoses
  • Comorbidities
  • Age
  • Current interventions
  • Functional Assessment
  • Vitals
  • Safety
  • History
  • Meds
  • Pre-morbid status/function
  • Recommendation of need for 3 therapies
  • Recommendation of need for 2 disciplines
  • Rehab potential
  • Areas where improvement is expected

15
Preadmission Screening
Example Pre-morbid function Pt. lives w/wife. Independent with ADLs, shopping, financial management, and recreation activities prior to onset of stroke. Rehabilitation potential Pt. has good potential for rehabilitation. He has shown some return of function, has good family support, and has a desire to get back to life as it was before his stroke.
16
Team Admission Assessment
  • Prior level of function
  • Required assistance
  • Living situation
  • Anticipated D/C plans
  • Patients rehab expectation
  • Individual FIMs with emphasis on findings
  • ROM and Strength limits
  • Sensation, tone, etc.
  • Community reintegration
  • Pain assessments
  • Summaries of findings

17
Poor Team Admission Example
Eating Eating Date 4/3 Date 4/3 Initials MSM FIM 5
Eating Eating Date Date Initials FIM
Meal assessed (B) L D Meal assessed (B) L D Current diet soft Current diet soft Intake mode oral Food texture soft
Thickened liquids No Thickened liquids No Thickness Thickness Dentures edentulous Finishes meal timely
Able to open packages Able to open packages Able to scoop Able to scoop Able to take food to mouth Able to cut
Noted Coughing Choking Neglect Neglect Neglect
Swallowing precautions Swallowing precautions Swallowing precautions Swallowing precautions Swallowing precautions Swallowing precautions
Bedside swallow results (Y) Bedside swallow results (Y) Swallow study results Y Swallow study results Y Positioning needs Positioning needs
Adaptive Equipment Needs Adaptive Equipment Needs Adaptive Equipment Needs Adaptive Equipment Needs Safety Needs Identified Safety Needs Identified
Findings Pt without dentures See bedside swallow eval Findings Pt without dentures See bedside swallow eval Findings Pt without dentures See bedside swallow eval Findings Pt without dentures See bedside swallow eval Findings Pt without dentures See bedside swallow eval Findings Pt without dentures See bedside swallow eval
18
Why This Is Poor
  • No indication that skilled intervention is needed
  • All items were not assessed
  • No safety needs identified
  • Findings do not provide justification for skilled
    therapy
  • No indication of why FIM was 5
  • No indication that intervention was needed on an
    inpatient basis
  • No indication that an interdisciplinary team is
    needed

19
Poor Team Admission Example
Toileting Toileting Toileting Date 1/3/04 Date 1/3/04 Date 1/3/04 Date 1/3/04 Initials MEM Initials MEM Initials MEM FIM 0 FIM 0
Toileting Toileting Toileting Date Date Date Date Initials Initials Initials FIM FIM
Able to pull clothing down Able to pull clothing down Able to pull clothing down Able to pull clothing down Able to pull clothing up Able to pull clothing up Able to pull clothing up Able to pull clothing up Able to pull clothing up Able to manage closures Able to manage closures Able to manage closures
Able to manage hygiene Bladder Able to manage hygiene Bladder Able to manage hygiene Bladder Able to manage hygiene Bladder Able to manage hygiene Bladder Able to manage hygiene Bladder Able to manage hygiene Bladder Able to manage hygiene Bowel Able to manage hygiene Bowel Able to manage hygiene Bowel Able to manage hygiene Bowel Able to manage hygiene Bowel
Able to follow precautions (i.e., Hip) Able to follow precautions (i.e., Hip) Able to follow precautions (i.e., Hip) Able to follow precautions (i.e., Hip) Able to follow precautions (i.e., Hip) Able to follow precautions (i.e., Hip) Able to follow precautions (i.e., Hip)
LIMITATIONS NOTED IN Balance Coordination Coordination Coordination Safety ROM Sequencing LE Strength LE Strength UE Strength Problem Solving
Adaptive Equipment Needs Adaptive Equipment Needs Adaptive Equipment Needs Adaptive Equipment Needs Adaptive Equipment Needs Adaptive Equipment Needs Adaptive Equipment Needs Adaptive Equipment Needs Adaptive Equipment Needs Adaptive Equipment Needs Adaptive Equipment Needs Adaptive Equipment Needs
Findings Pt did not have to void on eval Findings Pt did not have to void on eval Findings Pt did not have to void on eval Findings Pt did not have to void on eval Findings Pt did not have to void on eval Findings Pt did not have to void on eval Findings Pt did not have to void on eval Findings Pt did not have to void on eval Findings Pt did not have to void on eval Findings Pt did not have to void on eval Findings Pt did not have to void on eval Findings Pt did not have to void on eval
20
Why This Is Poor
  • Toileting was not assessed this is an important
    area for assessment to establish the medical
    necessity for OT

21
Poor Team Admission Example
Summary Of Findings Summary Of Findings

Overall clinical impression/rehab potential (qualified) Overall clinical impression/rehab potential (qualified)
SW Initials ___ Supportive family, will need supervision at home post rehab

SLP Initials ____ Recommend speech tx with focus on cog-ling tasks. Fair rehab potential to return home with supervision.

OT Initials ____ Pt to benefit from OT 5-6x/week for ADLs, transfers, strength/endurance to return home with family with supervision as appropriate

PT Initials ____ Good to return home alone after rehab with support services as needed.

Nursing Initials ____
22
Why This Is Poor
  • SW does not indicate need for skilled social
    services
  • SLP does not link need for therapy w/return home
    potential
  • PT does not show need for skilled therapy
    services
  • No indication that 24 hour setting for
    intervention is needed

23
Improved Example of Team Assessment
Eating Eating Date 4/3 Date 4/3 Initials MSM FIM 4
Eating Eating Date 4/4 Date 4/4 Initials LF FIM 4
Meal assessed (B) L D Meal assessed (B) L D Current diet soft Current diet soft Intake mode oral Food texture soft
Thickened liquids No Thickened liquids No Thickness Thickness Dentures yes Finishes meal timely N
Able to open packages Setup Able to open packages Setup Able to scoop Ind Able to scoop Ind Able to take food to mouth I Able to cut Mod A
Noted ? Coughing Choking ? Neglect ? Neglect ? Neglect
Swallowing precautions Pt needs to take small bites after all meals snacks, staff needs to check for pocketing of food Swallowing precautions Pt needs to take small bites after all meals snacks, staff needs to check for pocketing of food Swallowing precautions Pt needs to take small bites after all meals snacks, staff needs to check for pocketing of food Swallowing precautions Pt needs to take small bites after all meals snacks, staff needs to check for pocketing of food Swallowing precautions Pt needs to take small bites after all meals snacks, staff needs to check for pocketing of food Swallowing precautions Pt needs to take small bites after all meals snacks, staff needs to check for pocketing of food
Bedside swallow results ( Y) Bedside swallow results ( Y) Swallow study results Y Swallow study results Y Positioning needs Positioning needs
Adaptive Equipment Needs Adaptive Equipment Needs Adaptive Equipment Needs Adaptive Equipment Needs Safety Needs Identified Safety Needs Identified
Findings Bedside swallow exam attached. Requires ST is to teach patient safe swallowing techniques to ? risks of aspiration to upgrade diet . MEM Requires to OT to teach scanning compensatory techniques for eating. LF Findings Bedside swallow exam attached. Requires ST is to teach patient safe swallowing techniques to ? risks of aspiration to upgrade diet . MEM Requires to OT to teach scanning compensatory techniques for eating. LF Findings Bedside swallow exam attached. Requires ST is to teach patient safe swallowing techniques to ? risks of aspiration to upgrade diet . MEM Requires to OT to teach scanning compensatory techniques for eating. LF Findings Bedside swallow exam attached. Requires ST is to teach patient safe swallowing techniques to ? risks of aspiration to upgrade diet . MEM Requires to OT to teach scanning compensatory techniques for eating. LF Findings Bedside swallow exam attached. Requires ST is to teach patient safe swallowing techniques to ? risks of aspiration to upgrade diet . MEM Requires to OT to teach scanning compensatory techniques for eating. LF Findings Bedside swallow exam attached. Requires ST is to teach patient safe swallowing techniques to ? risks of aspiration to upgrade diet . MEM Requires to OT to teach scanning compensatory techniques for eating. LF
24
Why This Is Improved
  • Need for interdisciplinary team clearly
    identified
  • FIM score supported
  • Indication that intervention is needed across the
    day
  • Supports need for skilled OT and ST

25
Improved Example of Team Assessment
Toileting Toileting Toileting Date 1/3/04 Date 1/3/04 Date 1/3/04 Date 1/3/04 Date 1/3/04 Initials MEM Initials MEM Initials MEM Initials MEM Initials MEM FIM 4
Toileting Toileting Toileting Date 1/3/04 Date 1/3/04 Date 1/3/04 Date 1/3/04 Date 1/3/04 Initials LP Initials LP Initials LP Initials LP Initials LP FIM 4
Able to pull clothing down Mod A Able to pull clothing down Mod A Able to pull clothing down Mod A Able to pull clothing down Mod A Able to pull clothing up Mod A Able to pull clothing up Mod A Able to pull clothing up Mod A Able to pull clothing up Mod A Able to pull clothing up Mod A Able to pull clothing up Mod A Able to pull clothing up Mod A Able to manage closures Setup Able to manage closures Setup Able to manage closures Setup
Able to manage hygiene Bladder Independent Able to manage hygiene Bladder Independent Able to manage hygiene Bladder Independent Able to manage hygiene Bladder Independent Able to manage hygiene Bladder Independent Able to manage hygiene Bladder Independent Able to manage hygiene Bladder Independent Able to manage hygiene Bowel Mod A Able to manage hygiene Bowel Mod A Able to manage hygiene Bowel Mod A Able to manage hygiene Bowel Mod A Able to manage hygiene Bowel Mod A Able to manage hygiene Bowel Mod A Able to manage hygiene Bowel Mod A
Able to follow precautions (i.e., Hip) Supervision Able to follow precautions (i.e., Hip) Supervision Able to follow precautions (i.e., Hip) Supervision Able to follow precautions (i.e., Hip) Supervision Able to follow precautions (i.e., Hip) Supervision Able to follow precautions (i.e., Hip) Supervision Able to follow precautions (i.e., Hip) Supervision
LIMITATIONS NOTED IN Balance Coordination Coordination Coordination Safety ROM Sequencing Sequencing LE Strength UE Strength UE Strength Problem Solving Problem Solving
Adaptive Equipment Needs Grab bars at toilet Raised toilet Adaptive Equipment Needs Grab bars at toilet Raised toilet Adaptive Equipment Needs Grab bars at toilet Raised toilet Adaptive Equipment Needs Grab bars at toilet Raised toilet Adaptive Equipment Needs Grab bars at toilet Raised toilet Adaptive Equipment Needs Grab bars at toilet Raised toilet Adaptive Equipment Needs Grab bars at toilet Raised toilet Adaptive Equipment Needs Grab bars at toilet Raised toilet Adaptive Equipment Needs Grab bars at toilet Raised toilet Adaptive Equipment Needs Grab bars at toilet Raised toilet Adaptive Equipment Needs Grab bars at toilet Raised toilet Adaptive Equipment Needs Grab bars at toilet Raised toilet Adaptive Equipment Needs Grab bars at toilet Raised toilet Adaptive Equipment Needs Grab bars at toilet Raised toilet
Findings Morbid obesity impairs toileting. Requires OT for neuro reed to relearn safe toileting. MEM Requires PT training to ? balance, coordination, and LE strength. LP Findings Morbid obesity impairs toileting. Requires OT for neuro reed to relearn safe toileting. MEM Requires PT training to ? balance, coordination, and LE strength. LP Findings Morbid obesity impairs toileting. Requires OT for neuro reed to relearn safe toileting. MEM Requires PT training to ? balance, coordination, and LE strength. LP Findings Morbid obesity impairs toileting. Requires OT for neuro reed to relearn safe toileting. MEM Requires PT training to ? balance, coordination, and LE strength. LP Findings Morbid obesity impairs toileting. Requires OT for neuro reed to relearn safe toileting. MEM Requires PT training to ? balance, coordination, and LE strength. LP Findings Morbid obesity impairs toileting. Requires OT for neuro reed to relearn safe toileting. MEM Requires PT training to ? balance, coordination, and LE strength. LP Findings Morbid obesity impairs toileting. Requires OT for neuro reed to relearn safe toileting. MEM Requires PT training to ? balance, coordination, and LE strength. LP Findings Morbid obesity impairs toileting. Requires OT for neuro reed to relearn safe toileting. MEM Requires PT training to ? balance, coordination, and LE strength. LP Findings Morbid obesity impairs toileting. Requires OT for neuro reed to relearn safe toileting. MEM Requires PT training to ? balance, coordination, and LE strength. LP Findings Morbid obesity impairs toileting. Requires OT for neuro reed to relearn safe toileting. MEM Requires PT training to ? balance, coordination, and LE strength. LP Findings Morbid obesity impairs toileting. Requires OT for neuro reed to relearn safe toileting. MEM Requires PT training to ? balance, coordination, and LE strength. LP Findings Morbid obesity impairs toileting. Requires OT for neuro reed to relearn safe toileting. MEM Requires PT training to ? balance, coordination, and LE strength. LP Findings Morbid obesity impairs toileting. Requires OT for neuro reed to relearn safe toileting. MEM Requires PT training to ? balance, coordination, and LE strength. LP Findings Morbid obesity impairs toileting. Requires OT for neuro reed to relearn safe toileting. MEM Requires PT training to ? balance, coordination, and LE strength. LP
26
Why This Is Improved
  • Supports impact of morbid obesity (comorbidity on
    treatment)
  • Supports need for interdisciplinary team
  • Supports need for skilled OT and PT

27
Improved Example of Team Assessment
Summary Of Findings Summary Of Findings

Overall clinical impression/rehab potential (qualified) Overall clinical impression/rehab potential (qualified)
SW Initials ___ Skilled SW is needed to teach patient and family strategies for coping with disability. Pt. And family demonstrate readiness to participate in rehabilitation process

SLP Initials ___ Skilled ST is needed to teach patient compensatory strategies for safe swallowing. Pt. voices desire to improve eating.

OT Initials ___ Skilled OT is needed to teach balance, coordination, and safety techniques For toileting, transfers, bathing, dressing that will enable the patient to return home without supervision.

PT Initials ___ Skilled PT is required for gait training to enable the patient to ambulate safely at household distances. Pt needs to learn to use adaptive equipment, learn to incorporate hip precautions into ambulation and transfers
Nursing Initials___ Rehab nursing is required to manage pain, reinforce learning of ADLs, manage surgical wound site, reinforce nutritional education.
28
Why This Is Improved
  • All disciplines document need for skilled level
    of intervention
  • Supports need for interdisciplinary intervention
  • OTs identification of the need for toileting and
    bathing indicate the need for equipment that is
    not usually in OP clinics for patient training
    (bathtubs, commodes)
  • Rehab nursing clearly documents their role in the
    POC.

29
Documenting on the Patient Care Plan
  • The Patient Care Plan should include
  • Prioritized patient goals
  • Impairments, Activity, Participation
  • Planned Discharge Site
  • Interdisciplinary Long Term Goals
  • What disciplines will be involved in the care of
    the patient
  • Interventions

30
IAP Example
Admission Discharge
Impairments Osteoarthritis in knees, hips, back, R shoulder Osteoarthritis in knees, hips, back, R shoulder
Activities Impaired mobility, LB dressing, bathing toileting Improved to mod I in mobility, bathing dressing w/adaptive equip.
Participation Cant shop for groceries, Afraid to cook, cant perform job duties, cant play golf Able to shop for basic food items, can prepare simple meal, will return to work 2 weeks post d/c, return to golf 6 mo post d/c
31
Documenting Progress
  • At least weekly, a summary of the patients
    progress should be documented.
  • Document progress toward goals
  • Detail barriers to achievement of goals
  • Describe changes to the plan of care as
    appropriate
  • Describe patients response to treatment
  • State the justification for continued stay on the
    rehab unit

32
Poor Documentation of Progress
Occupational Therapy Weekly Weekly D/C
Summary Summary Summary Summary
Pt mod A with bathing, UB LB dressing strength endurance improved. Toileting _at_ Sup. 3 of 4 goals met. POC to co ntinue. Pt mod A with bathing, UB LB dressing strength endurance improved. Toileting _at_ Sup. 3 of 4 goals met. POC to co ntinue. Pt mod A with bathing, UB LB dressing strength endurance improved. Toileting _at_ Sup. 3 of 4 goals met. POC to co ntinue. Pt mod A with bathing, UB LB dressing strength endurance improved. Toileting _at_ Sup. 3 of 4 goals met. POC to co ntinue.
_____P.C. Perfect OTR_______3/15/04__________ _____P.C. Perfect OTR_______3/15/04__________ _____P.C. Perfect OTR_______3/15/04__________ _____P.C. Perfect OTR_______3/15/04__________
Signature Signature Date Date
33
Why This Is Poor
  • Note does not reflect skilled intervention
  • Note does not address the reasons that skilled
    services are needed the teaching of hip
    precautions, the teaching of adaptive equipment
    usage
  • Note does not document the need for continued
    skilled therapy

34
Improved Example of Progress
Occupational Therapy Weekly Weekly D/C
Summary Summary Summary Summary
Pt taught hip precautions during bathing, toileting, and lower body dressing with fair return demonstrations. Pt educated in use of reacher for functional activities, now independent with use. Pt morning ADL routine has improved speed. Pt continues to need skilled OT services to become independent with hip precautions in ADLs and to continue to reduce the amount of time required for morning ADLs. Pt taught hip precautions during bathing, toileting, and lower body dressing with fair return demonstrations. Pt educated in use of reacher for functional activities, now independent with use. Pt morning ADL routine has improved speed. Pt continues to need skilled OT services to become independent with hip precautions in ADLs and to continue to reduce the amount of time required for morning ADLs. Pt taught hip precautions during bathing, toileting, and lower body dressing with fair return demonstrations. Pt educated in use of reacher for functional activities, now independent with use. Pt morning ADL routine has improved speed. Pt continues to need skilled OT services to become independent with hip precautions in ADLs and to continue to reduce the amount of time required for morning ADLs. Pt taught hip precautions during bathing, toileting, and lower body dressing with fair return demonstrations. Pt educated in use of reacher for functional activities, now independent with use. Pt morning ADL routine has improved speed. Pt continues to need skilled OT services to become independent with hip precautions in ADLs and to continue to reduce the amount of time required for morning ADLs.
_____P.C. Perfect OTR_______3/15/04__________ _____P.C. Perfect OTR_______3/15/04__________ _____P.C. Perfect OTR_______3/15/04__________ _____P.C. Perfect OTR_______3/15/04__________
Signature Signature Date Date
35
Why This Is Improved
  • Details the skilled intervention provided by the
    therapist i.e., taught, educated
  • Addresses weekly short term functional goals
  • Summarizes daily treatment interventions
  • Documents need for continued skilled intervention

36
Daily Documentation of Medical Necessity
  • Daily documentation should show skilled need in
  • Weekly short term goals
  • Total units of therapy
  • Treatment/training
  • Daily comments

37
Poor Documentation of Goals
Weekly short-term goals Met Not Met Cont.
1. Pt will be indep. in grooming.
2. Pt will dress UB LB with supervision.
3. Pt will bath with min assist.
4. _______________________________________________
5. _______________________________________________
38
Why Is This Poor
  • Typical pt. w/hip replacement would not need
    skilled therapy to relearn basic ADLs

39
Improved Example of Goals
Weekly short-term goals Met Not Met Cont.
1. Pt will adhere to hip precautions in toileting and lower body dressing independently
2. Pt will use reacher in dressing and housekeeping tasks to maintain hip precautions independently
3. Pt will bathe lower body safely, maintaining balance and hip precautions at mod I.
4. Pt will complete morning ADL routine within 45 min at mod I
5. _______________________________________________
40
Why This Is Improved
  • Details the need for OT in ADLS
  • Documents specific area requiring learning it
    is not that patient needs to relearn how to put
    on clothes, bathe, etc., but that patient needs
    to learn how to use his hip precautions in each
    of these basic life activities
  • Puts ADLs into functional routine that has a
    meaningful measure to patient and family

41
What Constitutes a Skilled Service
  • Knowledge and training of a professional is
    necessary
  • Need should be indicated in initial evaluation
  • Evidence that skilled services were performed
    should be reflected in notes

42
What Constitutes a Skilled Service
  • Services must be of such a level of complexity
    and sophistication or the condition of the
    patient must be such that the services required
    can only be safely and effectively performed by
    qualified nurses and therapists.
  • Skilled services can be
  • Diagnostic and assessment
  • Designing treatment
  • Establishment of compensatory skills
  • Providing patient instruction
  • Reevaluations

43
Skilled versus Non-Skilled
Nonskilled Skilled
Observed patient trying to get out of bed. Pt unable to come to sitting without help. Training provided to facilitate independence in bed mobility. Tactile and verbal cuing provided to produce knee flexion and arm extension and push.
Pt expression - 2 with nurses. Pt. taught to use call light and respond bathroom. Pt able to perform sequence of pushing call light and responding to nurse 4/5.
Pt UB Dressing 4 Pt. taught strategies for compensation of left visual neglect to facilitate independence in dressing. Min assist required for buttoning shirt.
44
Denials
  • Why do payers tell us they deny claims?
  • Patient does not meet eligibility criteria
  • Services are not skilled
  • Services are not necessary for patients
    diagnosis, medical condition, or no assessed need

45
Denials
  • How can we avoid denials?
  • Document interventions clearly and precisely
  • Use active, descriptive verbs

46
Terms
Terms To Avoid Terms That Connote Skilled Services
Ambulate Gait training
Monitor Assess
Observe Evaluate
Tires easily Required rest periods due to..
Encourage Instruct/educate
Discuss Teach
Drills Tasks
Little change Continues to require
Pt performed Continues to progress
Supervised Analyze
Design
47
Questions? Next call - February 6 at 100 EST
  • Lisa Bazemore, MBA, MS, CCC-SLP
  • Lbazemore_at_erehabdata.com
  • (202) 588-1766
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