Re: PPS -Reply -Reply

[Guest guest]

In response to:

We are a medicare-certified

outpatient rehab agency that contracts with SNFs. Most

of the SNFs went under PPS in July. We have reduce our

staff size in most of these facilities because of the reimbursement,

but most of my problems stem from the lack of knowledge on

the part of the nursing home about the regs.....can u tell me

what ur experiences have been?

To the entire list:

>>>We go under PPS Jan 1, 1999. My biggest questions at this point are

" what rehab services I should provide on Saturday, Sunday, and

holidays... in order to maximize reimbursement, yet keep salary costs to a

minimum... as much as possible. Also, do we always have to use day

1-5 as our reference assessment period or can we use grace days on

weekend admits and shift our reference assessment period to days 2

through 6 or 3 through 7... etc.

I work in a hospital-based SNF with an average LOS of ~15 days. This

makes things a little different for us. Our therapists are employees of the

hospital, so we do not have any services that are " contracted. "

Any input or help would be appreciated,

Tina

Indpls, IN

>>> 09/03/98 09:50am >>>

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[Guest guest]

>>>You wrote:

This screen is not big enough to list all the struggles!!!!! I'll give it

a try

1. How to bill our outside contracts. (We are primarily an in-house

therapy

company)

2. How to pay for weekend staff.

3. How to get productivity up when so much of what we used to be able

to

bill for is now not billable.

That's a start, plenty more though.

My response:

>>>I manage an in-hospital SNF unit that goes under PPS 1/1/99. Our

therapists are employees of the hospital, so we do not have to deal with

contracted services. I do not have any insight to your Point #1.

On point #2, I am also struggling with weekend coverage. I am

wondering which patients " need treatment " and how to define this. I am

lucky, in the sense that I have a large pool of therapists to help cover the

weekends. As well, we have had some success hiring .1 FTEs into our

network at a " non-benefitted " rate... as opposed to PRN or contract

rates. My question is... how to decide which patients to treat on the

weekends and on holidays???????? Sunday in particular is a day that I

have always thought of as a day of rest!! Who do you treat and how do

you define " need for treatment?? "

Any insight would be great!!

Tina

Indpls, IN

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[Guest guest]

As far as weekends go, you should only have to see those patients who 1)

were admitted late in the week and did not receive their five days (more or

less, perhaps) that week, 2) missed a day of therapy during the week due to

illness, etc..., and 3) were admitted on Saturday or perhaps early on

Sunday. This obviously refers only to Med A /PPS patients and not to

managed care patients, as some MC contracts call for 7 days of therapy per

week. These conditions are obviously at the discretion of the attending

therapist who has developed the Rx plan and is monitoring continuity of

care, etc... You do not have to use days 1-5 but since your unit has a

relatively low LOS, you will likely need to see your weekend admits sometime

during the weekend for your department's reimbursement sake and most

importantly for the good of the short-term pt. who needs as many services as

you can provide. For example, a pt. who is transferred to your unit on Sat.

a.m. should not wait for therapy intervention until Monday. This disrupts

the continuity of care. You could: 1)eval & Rx the pt. on Sat. and then use

days 1-5, or 2)eval & Rx the pt. on Sun a.m. and then use days 2-6. There

are many scenarios to this approach; hope this provides some info as far as

weekend staffing goes.

Dean Myers, MS, PT

Re: PPS -Reply -Reply

In response to:

We are a medicare-certified

outpatient rehab agency that contracts with SNFs. Most

of the SNFs went under PPS in July. We have reduce our

staff size in most of these facilities because of the reimbursement,

but most of my problems stem from the lack of knowledge on

the part of the nursing home about the regs.....can u tell me

what ur experiences have been?

To the entire list:

>>>We go under PPS Jan 1, 1999. My biggest questions at this point are

" what rehab services I should provide on Saturday, Sunday, and

holidays... in order to maximize reimbursement, yet keep salary costs to

a

minimum... as much as possible. Also, do we always have to use day

1-5 as our reference assessment period or can we use grace days on

weekend admits and shift our reference assessment period to days 2

through 6 or 3 through 7... etc.

I work in a hospital-based SNF with an average LOS of ~15 days. This

makes things a little different for us. Our therapists are employees of

the

hospital, so we do not have any services that are " contracted. "

Any input or help would be appreciated,

Tina

Indpls, IN

>>> 09/03/98 09:50am >>>

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