How Changes to Medicare Have Affected Therapy in Skilled Nursing Facilities

Part Two:  MDS 3.0 and RUGs IV

Just when we felt that we could breathe easily, as we had prepared our staff adequately for the RACs, we found out that there were going to be additional changes effective October 1st, 2010 that affected Medicare Part A services.  With the implementation of MDS 3.0 and RUGs IV, we were going to see another change that greatly impacted the therapy world!  The main changes that affected therapy included:

1)    Changing what constitutes Extensive Services;

2)    Doing away with “projections” for Admit MDS periods;

3)    Doing away with “capturing” IV fluids/meds from the hospital;

4)    Changing the definition of “concurrent therapy;”

5)    Changing the Sections of the MDS;

6)    Changing billing practices for modalities, and

7)    Adding the Short Stay Assessment

Once again, we had to provide training and education to our therapy staff, in preparation for these changes, but, no matter how well prepared we tried to be for this “second blow,” we still took a hit, nonetheless, as some changes were well out of our control (like the Short Stay Assessments and elimination of projections).  The best tool we have in regards to limiting the effects of these changes is constant communication with nursing staff.  We strongly encourage therapist to notify the charge nurse, DON, and/or administrator anytime we will not be able to complete an evaluation on the day of admission.  We must also be great patient advocates; it is no longer acceptable to just document “patient unavailable” of “missed session secondary to illness.”  We must have ongoing, open communication with nursing staff to insure that patients are treated appropriately at all times; this may involve sending a resident back to the hospital as opposed to leaving them in the facility when they have experienced a decline in their medical status.


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Odyssey Rehabilitation – Partners with long-term care facilities to provide affordable, compassionate PHYSICAL, OCCUPATIONAL and SPEECH THERAPY services in addition to complete, comprehensive management for your rehab department.
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