We’d like to know your opinions on continuing competence courses.  Here’s a basic Word form that allows for lots of comments.  Open it up, fill it in, and email to Support@CEUs-ToGo.com.  Don’t use Word?  Print the Adobe version and fax to 512-255-3548.

Thanks for sharing!

 Word Document: Download
 Adobe PDF: Download

There was a time when trade unions were necessary and welcome — a time when employees worked in squalid conditions, for long hours, with little pay.

The US labor unions were more concerned with employee wages than with safety.  More concerned with the dollars than with the people who earned them.  It is not surprising that the AFL-CIO declined to support the first occupational safety act submitted by President LBJ in 1968.

Growing up in Toledo, Ohio — smack dab in the middle of some of the largest unionized industries in the country — taught me something about unions.  None of it good.

Unions are still more concerned with the money than they are the people.  I’ve witnessed unions drive a good company right into bankruptcy with their outrageous demands.  Watched as their members lost pay and benefits during long strikes.  Acting, of course, “for the good of the employees” which, of course, had nothing really to do with their agenda.

It was with a heavy heart that I read the latest article in Home Health Care Management & Practice in an attempt to educate unwary home health agencies of the sneaky tactics used by unions to weasil their way into the workforce.

Get a copy of the article and read it:  “What To Do About a Union Neutrality Agreement”, by John C Gilliland II, Esq., Home Health Care Management & Practice, Vol 21, No. 4, June 2009, pp 255-258.

Take a look at the current conditions in Detroit and think long and hard about the “benefits” of a union.

CEUs-ToGo would like to congratulate the Speech and Language Pathologist community of providers!

As of July 1, 2009, SLPs in private practice will be able to bill and receive direct payment for their services provided under Medicare.

Don’t forget - the SLP must first enroll in the Medicare system in the same manner as physical and occupational therapists in private practice.  Enrollment begins June 2.

Happy billing!

Trailblazer (the fiscal intermediary for Part A and carrier for Part B in the states of Colorado, New Mexico, Oklahoma, Texas, and the Indian Health Service) conducted a “Probe” of billed SNF payments.  They focused on the highest paying RUG groups (what else would we expect), selecting “a random sample of 100 claims from 15 of the top billing providers of SNF services with dates of service July 2007 through December 2007.”

The results?

“Medical Review denied or partially denied services on 34 percent of the total claims reviewed. The error rate for this widespread sample was 13.5 percent.”

As a therapist who has practiced in the SNF setting for several years, I’m disturbed by their findings.  Here are the reasons for denial — in Trailblazer’s own words. . .with my comments thrown in for good measure.

“Based on the results of the probe review, Medical Review identified the following problem areas:

• Utilization of higher levels of intensity of rehabilitation than were medically necessary.

What medical condition ISN’T worthy of the highest levels of therapy the patient can tolerate?!?  After all, they are in a SNF to get the maximum level of therapy possible in order to send them home as quickly as possible.  If a patient can tolerate three hours of therapy, then by golly give him three hours of therapy!

• Patients reached their functional potential without being turned over to restorative care in a reasonable time frame.

This one I’ve got to agree with, and I’ve seen it myself.  Get them healthy, get them safe, and then let them practice with the RNA or, better yet, send them home for more training with home health.

• Therapies were continued past the restoration of the patient’s prior level of functioning.

This denial I find rather disturbing.  I can’t tell you the number of times a patient has said to me, “You know, I used to ___[walk, go grocery shopping, enjoy an evening out with my family, ride my bike, get out of my own bed]___ but I haven’t been able to for so long because ___[my knees hurt too bad, my back was causing so much pain, I was afraid of falling]___ and now that I have ___[my knee replaced, my back surgery, better pain medicine management, this new walker]___ I’d like to get back to the way I was.”

Well, not according to Medicare.  According to Medicare I can only give you enough therapy to get you back into a wheelchair because that’s what you used in the customary span of time before you went to the hospital.  Sure, you COULD walk again, you COULD return to a better quality of life, but not on MEDICARE’s dime.

ALL YOU PEOPLE OUT THERE CONSIDERING A NATIONALIZED HEALTHCARE SYSTEM - REMEMBER THIS DENIAL!!

• Therapies were provided to individuals who were not reasonably capable of participation or of making/sustaining gains.

“Sustaining” gains — tell that to the Parkinson’s patient who needs intense therapy just to maintain their present levels. . .or the CVA who shows potential, but since you aren’t God and really aren’t sure what the outcome could be. . .or . . .or. . .or

• Documentation did not support the need for continued care in an SNF:
  • Patients had reached their potential and were medically stable.
  • Documentation did not indicate participation of medically stable patients in ordered therapies.
  • No gains were accomplished due to declining physical health issues.
• Utilization of higher RUG codes than medically necessary:
  • Documentation did not support the intense levels of skilled therapy.
  • Speech-language pathology was ordered for cognitive deficits when documentation indicated there were no deficits.
  • Patients were not capable of participating in high levels of intense therapy.
• Documentation received was incomplete:
  • Minimum Data Set (MDS) was not in the National Repository.
  • Medical records did not contain one or a combination of the following documents:
    • Physician orders for SNF services.
    • Certification/recertification for SNF services. “

Do you know how ICD-9 codes relate to the exceptions process?

The Medicare Claims Processing Manual, Chapter 5 has all the guidelines.  Now, if you don’t relish digging through all the documentation, here’s a cheat sheet to help.  I keep one in my clipboard as a reminder.

REMEMBER:  This document is an EXCERPT only.  Please read all applicable documentation for guidelines.

 Therapy Cap ICD-9 Exception List: Download

The “Netter Book” was invaluable not only during my days in therapy school, but my poor book is falling apart from all the use it’s gotten in the clinic.

I even bought the Netter flash cards.

Did you know you can see the Netter images on-line?  They are available for viewing at www.NetterImages.com.  You can view the labeled picture, or an unlabeled picture.

The new course - Using the Wii in the Clinic:  Pediatrics and Adults — is now available.  It has been submitted to Texas for state approval for 1.25 contact hours and will become approved in North Carolina soon.

One of the most difficult aspects of trying to read and learn about Medicare, or anything government for that matter, is getting through their TLAs.  That’s right — the miriad of Three Letter Acronyms (TLA).

It’s like swimming in alphabet soup.

So, here it is.  The ultimate acronym guide, straight from the Centers for Medicare & Medicaid — every TLA and FLA (four letter acronym) you’ve ever struggled to find.

This document is not for the faint of heart.  The bloomin’ thing is 112 pages!

Enjoy!

 The Complete List of CMS Acronyms: Download

Did you know that a new ABN form will be implemented on March 1st?

According to the Center for Medicare & Medicaid Services (CMS), “An ABN is a written notice that a provider/supplier gives to a Medicare patient before items or services are rendered when the provider/supplier believes Medicare probably/certainly will not pay for some or all of the items or services.”

The new ABN replaces the previous ABN-G, ABN-L and NEMB forms.

Trailblazer Health Enterprises, the Medicare Administrative Contractor (MAC) for Colorado, New Mexico, Oklahoma, Texas, and the Indian Health Service, is offering training on the new ABN.  This is web-based training, available to anyone with a Windows 98, 2000, or XP system (Vista systems don’t work with their teleconference provider).  The training is FREE, on March 4, 11:00am-1:00pm CT, noon-2:00pm ET.  You must register for the training.

Register at TrailblazerHealth Part B Revised ABN of Non-Coverage Web-Based Training

To access the CMS information on this topic, see CMS FFS ABN-G and ABN-L

This should be a “duh” moment, but the conclusion of this study opens a can a worms.

In the February issue of Archives of Physical Medicine and Rehabilitation is an original research article that concludes that “visual observation is not a valid and reliable method to assess partial weight-bearing.”

The ability to determine the weight-bearing (WB) level during active walking was no better for therapists who were experienced in PWB, than for therapists who did not tend to treat that type of injury.

Each therapist watched the ambulating patient and then marked on a visual analogue scale (VAS), sectioned in 10% increments, the level of weight-bearing they were observing.

I was stunned at the variation in estimations; with ranges from 10% WB to 100% WB and everything in-between on the same patient during the same ambulation sample.

And…this wasn’t an isolated incident.  Huge ranges are noted more frequently than not.

But, the problem is this:  The study also reports that neither palpation, nor using a bathroom scale is accurate, either.

So, how are therapists supposed to accurately assess weight-bearing without expensive equipment?  I’d like to know.