{"id":943,"date":"2012-12-11T09:08:00","date_gmt":"2012-12-11T06:08:00","guid":{"rendered":"https:\/\/www.pragmait.com\/therapyboss\/?p=943"},"modified":"2021-10-14T14:52:52","modified_gmt":"2021-10-14T11:52:52","slug":"home-health-maintenance-therapy-for-dummies","status":"publish","type":"post","link":"https:\/\/pragmait.com\/therapyboss\/home-health-maintenance-therapy-for-dummies\/","title":{"rendered":"Home Health Maintenance Therapy for Dummies"},"content":{"rendered":"

In October, 2012, the settlement agreement in the Jimmo v. Sebelius class action lawsuit was reached.\u00a0The plaintiffs in this case were seeking to challenge denials of Medicare claims based on lack of progress in patient therapy care.\u00a0This settlement agreement revises the accepted industry definition of covered services and opens up conversation and debate about maintenance therapy as a home health service and has many scratching their heads wondering just what the heck is home health maintenance therapy?<\/p>\n

According to the local coverage determination for Home Health Physical Therapy, \u201cIf the patient\u2019s clinical condition requires the specialized skill, knowledge and judgment of a qualified therapist to design or establish a maintenance (sic) program relatd (sic) to the patient\u2019s illness or injury, in order to ensure the safety of the patient and the effectiveness of the program, such services are covered.<\/em>\u201d\u00a0 In a nutshell, home health maintenance therapy is a service provided by a qualified Physical Therapist, Occupational Therapist or Speech Language Pathologist where periodic monitoring or adjustment of a care plan is required.\u00a0For example, a Physical Therapist determines that his services are no longer required on a regular basis but needs to choose a home exercise program based on his clinical judgment that may or may not be the most beneficial to the patient in the long term.\u00a0He may decide to transition the patient to a maintenance program where the patient performs the exercises on his own with the assistance of caregivers or family and the qualified therapist visits the patient a few times a month to ensure that the patient\u2019s level of function continues to improve or stabilizes and reduces the possibility of a decline in function.<\/p>\n

Maintenance therapy can only be provided by qualified therapists \u2013 Physical Therapists, Occupational Therapists or Speech Language Pathologists.\u00a0Due to the complexity and sophistication of therapy procedures required, a PTA or COTA is not qualified to evaluate or make changes to a treatment plan in home health.<\/p>\n

And maintenance therapy is coded differently on the PPS end of episode claim submitted by home health providers so it is important that these services are identified on each clinical note so that they will be billed appropriately.<\/p>\n