3-hour rule: 172 minutes/Neuropsych

[Guest guest]

Thanks for the response, and also to Weiss.

We did speak to our FI (UGS) about this and it was suggested that we

needn't worry about missing 180 minutes by just a few minutes on a

given day, as long as it wasn't a consistent pattern. " Don't let your

therapists over-sweat this " was the basic advice.

Our Saturday coverage is being re-examined to try to reach 3 hours on

patients admitted that week since they usually don't make 3 hours on

the first day.

We were also able to clarify that Neuropscyh and Rehab Nursing are

not covered (we had previously been under the impression that nursing

is covered if teaching is involved).

>

> Don't you love CMS and the FI's? I had spoken with Pete with

CMS and he had immediately deferred to the FI's. My FI (Mutual of

Omaha, who tends to be among the strictest) didn't provide much more

information other than the generic response you've heard, " you need

to meet the 3 hour guideline " . I am no longer at my former facility,

however these are some of the ways we addressed the 3 hour rule:

In order to meet the strictest compliance we:

> 1. Similar to you we added a 30 minute buffer

> 2. Stressed the importance of documentation (i.e. a patient

who had to take a bathroom break during therapy...the therapists

would make sure that they provided appropriate education and

incorporated this into the patient's therapy as a therapeutic

activity when possible)

> 3. Completely revised weekend therapy...for example we found

that patients that came in late on Thursday nights were impacted the

most. Since they usually didn't receive therapy on Thursday, they had

to receive 3 hours on five of the following six days: Friday,

Saturday, Sunday, Monday, Tuesday, and Wednesday. We felt very

confident that 3 hours on Friday, Monday, Tuesday, Wednesday and

Thursday could be met, but we still needed to provide 3 hours of

therapy for certain patients on the weekend. Obviously we also had

to balance this out with labor costs from an operational standpoint.

> 4. We had experimented with some palm technology in our SNF

> division for a while and had discussed bringing it back to the IRF

> setting in order to actually allow therapists to generate a real-

time monitor of the time spent with the patients.

> 5. Introduced Start and End times on our forms. Working for

an HCA facility, they required us to work with the same documentation

> guidelines that outpatient worked under (8 minute rule). Therefore

we had to require start/end times in order to successfully pass

internal audits.>

>

> Hope this helps, in my new role we're providing technology that

> automates the documentation and billing process and thus allows the

> generation of 3 hour reports that can be customized based upon an

> individual facility's parameters and requirements.

>

> Thanks, Nick

> Nick Kagal

> Southwest Regional Vice President

> MediServe Information Systems

> Office/Fax:

> Mobile:

> nkagal@...

> www.mediserve.com

>

> Optimizing Care through Efficiency

>

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