It has recently come to our attention that Palmetto GBA is issuing ADR denials on home health claims for patients whose therapy care plan does not qualify goals as long term and short term. Palmetto has jurisdiction over AL, AR, FL, GA, IL, IN, KY, LA, MS, NM, NC, OH, OK, SC, TN, and TX. […]

On November 6, 2014, the Centers for Medicare & Medicaid Services (CMS) published the Final Rule for CY 2015 Home Health Prospective Payment System Rate Update; Home Health Quality Reporting Requirements; and Survey and Enforcement Requirements for Home Health Agencies. You can find the full text here. It can be a fun read for some […]

This comes from Palmetto GBA, a Medicare fiscal intermediary, and it pertains to easily the most crucial aspect of clinical documentation for therapists and, frankly, for any type of clinician. We felt that it was important to share this with our community at large as it is direct instruction from Medicare regarding the shaping of […]

The Centers for Medicare & Medicaid Services (CMS) has announced the transition from OASIS-C to OASIS-C1/ICD-9 beginning January 1, 2015. We’ll have a more in-depth article about that soon but for right now, it feels like a good opportunity to talk about OASIS Assessments in more general terms. For starters, the two best resources for […]

On Monday, July 7th, CMS Released the Proposed Rule to affect agencies starting in calendar year 2015. You can find a copy of the full text here. We here at therapyBOSS thought you might prefer a short summary over a 56 page document in itty bitty print so here we go. Let’s start with the […]

The biggest mistake in home health care is our treatment of maintenance therapy as a separate and incomprehensible monster distinct from traditional rehabilitative therapy treatment. The truth is, there is little mystique when it comes to the home health maintenance therapy documentation. At its core, the same rules apply. Is it reasonable? Is it necessary? […]

In October, 2012, the settlement agreement in the Jimmo v. Sebelius class action lawsuit was reached. The plaintiffs in this case were seeking to challenge denials of Medicare claims based on lack of progress in patient therapy care. This settlement agreement revises the accepted industry definition of covered services and opens up conversation and debate about maintenance […]

MYTH:  If a patient is no longer homebound they must be discharged by home health. FACT:  While it is true that the patient no longer qualifies for home health services when they stop being homebound, patients who still require skilled therapy services may continue to receive those services from an agency under the Outpatient Therapy […]

There’s little doubt that if a vote was taken to nominate the most despised regulation in the home health industry, the 13th and 19th visit therapy re-assessment requirement would be the favorite to take home the grand prize. The Centers for Medicare & Medicaid Services (CMS) enacted this requirement as a way to prevent unnecessary […]