Re: Documenting clock times in Acute Care

[Guest guest]

This just came up for us, but not from billing. I am interested in seeing the

replies because we are having a debate on wether this really applies.

Challenging too when we go into a room and get interupted, leave, come back,

patient isn't ready, leave... you get the idea.

Is this Medicare B REQUIREMENT or an INTERPRETATION?

katesel strimbeck PT, MS

PT Supervisor

St. 's Hospital

Albany, New York

katesels@...

> Good morning, our billing department (we are a 500 bed acute care/med/surg

hospital)has told us we need to document the clock time for evals and treats,

both start time and finish time. This will cause issues for us when we

co-treat/eval between PT and OT. Does anyone else do this and how have you

handled the issue of cotreating with another issue? Thanks!

> Amory, St. Luke's Hospital

>

>

>

[Guest guest]

My experience with all this is to challenge the source to verify that it is a

Part A issue. Do not assume hospital adminstrators have any idea of the

difference. My personal experience says most do not.

Jim Dunleavy PT, MS

Re: Documenting clock times in Acute Care

This just came up for us, but not from billing. I am interested in seeing the

replies because we are having a debate on wether this really applies.

Challenging too when we go into a room and get interupted, leave, come back,

patient isn't ready, leave... you get the idea.

Is this Medicare B REQUIREMENT or an INTERPRETATION?

katesel strimbeck PT, MS

PT Supervisor

St. 's Hospital

Albany, New York

katesels@...

> Good morning, our billing department (we are a 500 bed acute care/med/surg

hospital)has told us we need to document the clock time for evals and treats,

both start time and finish time. This will cause issues for us when we

co-treat/eval between PT and OT. Does anyone else do this and how have you

handled the issue of cotreating with another issue? Thanks!

> Amory, St. Luke's Hospital

>

>

>

[Guest guest]

We document clock times even with co-treats. We use the Medicare guidelines for

allocating the times spent by OT and PT so we don't over charge the patient.

From: PTManager [mailto:PTManager ] On Behalf Of

A

Sent: Tuesday, August 10, 2010 9:47 AM

To: PTManager

Subject: Documenting clock times in Acute Care

Good morning, our billing department (we are a 500 bed acute care/med/surg

hospital)has told us we need to document the clock time for evals and treats,

both start time and finish time. This will cause issues for us when we

co-treat/eval between PT and OT. Does anyone else do this and how have you

handled the issue of cotreating with another issue? Thanks!

Amory, St. Luke's Hospital

[Guest guest]

Our billing department also asked for timed notes. They are more

concerned about us documenting the amount of minutes spent for each

treatment (i.e. " gait training- 16 min.; therapeutic exercise- 13

min. " ) as opposed to start times and end times for the entire treatment.

However, we are now doing both. This was initiated after an in house

audit by IPRO.

As far as co-treatments go, we only bill a patient for the amount time

we spend with the patient. If two therapists co-treat for 1 hour, one

therapist bills for 30 min, and the other bills for 30 min. We try to

avoid co-treatments whenever possible.

Sheila Farmakopoulos, MSPT

Westchester Medical Center

Supervisor of Physical Therapy

From: PTManager [mailto:PTManager ] On

Behalf Of A

Sent: Tuesday, August 10, 2010 9:47 AM

To: PTManager

Subject: Documenting clock times in Acute Care

Good morning, our billing department (we are a 500 bed acute

care/med/surg hospital)has told us we need to document the clock time

for evals and treats, both start time and finish time. This will cause

issues for us when we co-treat/eval between PT and OT. Does anyone else

do this and how have you handled the issue of cotreating with another

issue? Thanks!

Amory, St. Luke's Hospital

[Guest guest]

This issue is also stemming from private insurers who do not have any clue of

the applicability of the medicare rules in acute care setting. Just last week, I

sat in a chart audit session where a private insurance is trying to cut down

charges on patients. Rehab took a big hit because we did not document time in

and out and therapy duration. I told the insurance rep that this is not the

standard in our documentation as this medicare rule does not apply in acute care

setting because of the reasons stated below but she just simply said-- you know

the rule, you didn't document it, then it didn't happen... i showed her that the

documentation clearly stated what transpired but not exactly in the language she

was expecting.. She only wanted to pay 15 minutes of therapy a day " because that

is what the documentation shows " . I even challenge her with the " if that patient

who had a traumatic hip fracture is your mother, you wouldn't want us rushing

her therapy to 15 minutes, right? " Didn't work.. And so, as an action plan, we

are also challenged to document time in and time out, therapy duration, and

charges in our notes as of that day.

I am interested in how other hospitals are handling this issue.

Earnest Escobar, PT

Bethesda Memorial

Boynton Beach FL

-----Original Message-----

From: PTManager

To: PTManager

Sent: Wed, Aug 11, 2010 1:29 pm

1a. Documenting clock times in Acute Care

Posted by: " A " amorym@... lehigh_1999

Date: Tue Aug 10, 2010 11:42 am ((PDT))

Good morning, our billing department (we are a 500 bed acute care/med/surg

ospital)has told us we need to document the clock time for evals and treats,

oth start time and finish time. This will cause issues for us when we

o-treat/eval between PT and OT. Does anyone else do this and how have you

andled the issue of cotreating with another issue? Thanks!

ichael Amory, St. Luke's Hospital

1b. Re: Documenting clock times in Acute Care

Posted by: " katesel strimbeck " katesels@... kstrimbeck

Date: Tue Aug 10, 2010 3:38 pm ((PDT))

This just came up for us, but not from billing. I am interested in seeing the

eplies because we are having a debate on wether this really applies.

hallenging too when we go into a room and get interupted, leave, come back,

atient isn't ready, leave... you get the idea.

s this Medicare B REQUIREMENT or an INTERPRETATION?

atesel strimbeck PT, MS

T Supervisor

t. 's Hospital

lbany, New York

atesels@...

c. Re: Documenting clock times in Acute Care

Posted by: " JIMDPT@... " JIMDPT@...

Date: Tue Aug 10, 2010 7:33 pm ((PDT))

My experience with all this is to challenge the source to verify that it is a

art A issue. Do not assume hospital adminstrators have any idea of the

ifference. My personal experience says most do not.

Jim Dunleavy PT, MS

1d. Re: Documenting clock times in Acute Care

Posted by: " SKIP ROY " sroy@... jeepdrivernc

Date: Wed Aug 11, 2010 9:59 am ((PDT))

We document clock times even with co-treats. We use the Medicare guidelines for

llocating the times spent by OT and PT so we don't over charge the patient.

[Guest guest]

Our EMR system (CERNER) solves all of those issues. Therapists have required in

and out times and charges must be verified in system with total duration.

Stowers, PTA, Ed.D.

Clinical Manager Rehabilitation

CHRISTUS St. Regional Medical Center

Santa Fe, NM

>

>

> This issue is also stemming from private insurers who do not have any clue of

the applicability of the medicare rules in acute care setting. Just last week, I

sat in a chart audit session where a private insurance is trying to cut down

charges on patients. Rehab took a big hit because we did not document time in

and out and therapy duration. I told the insurance rep that this is not the

standard in our documentation as this medicare rule does not apply in acute care

setting because of the reasons stated below but she just simply said-- you know

the rule, you didn't document it, then it didn't happen... i showed her that the

documentation clearly stated what transpired but not exactly in the language she

was expecting.. She only wanted to pay 15 minutes of therapy a day " because that

is what the documentation shows " . I even challenge her with the " if that patient

who had a traumatic hip fracture is your mother, you wouldn't want us rushing

her therapy to 15 minutes, right? " Didn't work.. And so, as an action plan, we

are also challenged to document time in and time out, therapy duration, and

charges in our notes as of that day.

> I am interested in how other hospitals are handling this issue.

>

> Earnest Escobar, PT

> Bethesda Memorial

> Boynton Beach FL

>

> -----Original Message-----

> From: PTManager

> To: PTManager

> Sent: Wed, Aug 11, 2010 1:29 pm

>

> 1a. Documenting clock times in Acute Care

> Posted by: " A " amorym@... lehigh_1999

> Date: Tue Aug 10, 2010 11:42 am ((PDT))

> Good morning, our billing department (we are a 500 bed acute care/med/surg

> ospital)has told us we need to document the clock time for evals and treats,

> oth start time and finish time. This will cause issues for us when we

> o-treat/eval between PT and OT. Does anyone else do this and how have you

> andled the issue of cotreating with another issue? Thanks!

> ichael Amory, St. Luke's Hospital

> 1b. Re: Documenting clock times in Acute Care

> Posted by: " katesel strimbeck " katesels@... kstrimbeck

> Date: Tue Aug 10, 2010 3:38 pm ((PDT))

> This just came up for us, but not from billing. I am interested in seeing the

> eplies because we are having a debate on wether this really applies.

> hallenging too when we go into a room and get interupted, leave, come back,

> atient isn't ready, leave... you get the idea.

> s this Medicare B REQUIREMENT or an INTERPRETATION?

>

> atesel strimbeck PT, MS

> T Supervisor

> t. 's Hospital

> lbany, New York

> atesels@...

>

> c. Re: Documenting clock times in Acute Care

> Posted by: " JIMDPT@... " JIMDPT@...

> Date: Tue Aug 10, 2010 7:33 pm ((PDT))

> My experience with all this is to challenge the source to verify that it is a

> art A issue. Do not assume hospital adminstrators have any idea of the

> ifference. My personal experience says most do not.

> Jim Dunleavy PT, MS

> 1d. Re: Documenting clock times in Acute Care

> Posted by: " SKIP ROY " sroy@... jeepdrivernc

> Date: Wed Aug 11, 2010 9:59 am ((PDT))

> We document clock times even with co-treats. We use the Medicare guidelines

for

> llocating the times spent by OT and PT so we don't over charge the patient.

>

>

[Guest guest]

Just sat in on a compliance meeting at our hospital. Discussing Acute Care (not

IRF) issues related to medicare billing and minutes, supervision of students

too. So this is a timely thread.

My thoughts:

I have Been doing some investigation too. Regs are NOT clear for Part A, and I

think erring on the side of Part B regs in Acute Care is understandable, but for

some of us very burdensome. Obviously for those of us in acute care settings

and our hospitals have to make a decision on how much time and effort therapists

will spend on documentation and counting mintues. Rarely in my setting to we

just walk into a room and get started, we face many interruptions. My staff can

see as few as 5 patients in an 8 hour day if they have to travel unit to unit

and face interruptions (non ortho by the way that is one unit and much faster).

Remember some interpretation has to do with who your Medicare contractor is and

how THEY interpret things. Then as Earnest points out depends on the Auditor

too. It is all VERY hard to understand and keep track of. A contractor, auditor

and consultant can ALL have different interpretations.

Keep the thread up, this is very important stuff!

katesel strimbeck PT, MS

PT Supervisor

St. 's Hospital

Albany, New York

katesels@...

>

>

> This issue is also stemming from private insurers who do not have any clue of

the applicability of the medicare rules in acute care setting. Just last week, I

sat in a chart audit session where a private insurance is trying to cut down

charges on patients. Rehab took a big hit because we did not document time in

and out and therapy duration. I told the insurance rep that this is not the

standard in our documentation as this medicare rule does not apply in acute care

setting because of the reasons stated below but she just simply said-- you know

the rule, you didn't document it, then it didn't happen... i showed her that the

documentation clearly stated what transpired but not exactly in the language she

was expecting.. She only wanted to pay 15 minutes of therapy a day " because that

is what the documentation shows " . I even challenge her with the " if that patient

who had a traumatic hip fracture is your mother, you wouldn't want us rushing

her therapy to 15 minutes, right? " Didn't work.. And so, as an action plan, we

are also challenged to document time in and time out, therapy duration, and

charges in our notes as of that day.

> I am interested in how other hospitals are handling this issue.

>

> Earnest Escobar, PT

> Bethesda Memorial

> Boynton Beach FL

>

> -----Original Message-----

> From: PTManager

> To: PTManager

> Sent: Wed, Aug 11, 2010 1:29 pm

>

> 1a. Documenting clock times in Acute Care

> Posted by: " A " amorym@... lehigh_1999

> Date: Tue Aug 10, 2010 11:42 am ((PDT))

> Good morning, our billing department (we are a 500 bed acute care/med/surg

> ospital)has told us we need to document the clock time for evals and treats,

> oth start time and finish time. This will cause issues for us when we

> o-treat/eval between PT and OT. Does anyone else do this and how have you

> andled the issue of cotreating with another issue? Thanks!

> ichael Amory, St. Luke's Hospital

> 1b. Re: Documenting clock times in Acute Care

> Posted by: " katesel strimbeck " katesels@... kstrimbeck

> Date: Tue Aug 10, 2010 3:38 pm ((PDT))

> This just came up for us, but not from billing. I am interested in seeing the

> eplies because we are having a debate on wether this really applies.

> hallenging too when we go into a room and get interupted, leave, come back,

> atient isn't ready, leave... you get the idea.

> s this Medicare B REQUIREMENT or an INTERPRETATION?

>

> atesel strimbeck PT, MS

> T Supervisor

> t. 's Hospital

> lbany, New York

> atesels@...

>

> c. Re: Documenting clock times in Acute Care

> Posted by: " JIMDPT@... " JIMDPT@...

> Date: Tue Aug 10, 2010 7:33 pm ((PDT))

> My experience with all this is to challenge the source to verify that it is a

> art A issue. Do not assume hospital adminstrators have any idea of the

> ifference. My personal experience says most do not.

> Jim Dunleavy PT, MS

> 1d. Re: Documenting clock times in Acute Care

> Posted by: " SKIP ROY " sroy@... jeepdrivernc

> Date: Wed Aug 11, 2010 9:59 am ((PDT))

> We document clock times even with co-treats. We use the Medicare guidelines

for

> llocating the times spent by OT and PT so we don't over charge the patient.

>

>

[Guest guest]

If you are co-treating at the same time, Medicare Part B indicates that you can

only bill one service at a time. It is the time actually spent with the

patient; if you walk away, answer a phone, etc., you need to subtract that

portion of time from the treatment given. Go to cms.gov website and type in

Chapter 15. It has all the current rules regarding therapy. Sue Whitney PT

________________________________

To: PTManager

Sent: Tue, August 10, 2010 4:35:04 PM

Subject: Re: Documenting clock times in Acute Care

This just came up for us, but not from billing. I am interested in seeing the

replies because we are having a debate on wether this really applies.

Challenging too when we go into a room and get interupted, leave, come back,

patient isn't ready, leave... you get the idea.

Is this Medicare B REQUIREMENT or an INTERPRETATION?

katesel strimbeck PT, MS

PT Supervisor

St. 's Hospital

Albany, New York

katesels@...

> Good morning, our billing department (we are a 500 bed acute care/med/surg

>hospital)has told us we need to document the clock time for evals and treats,

>both start time and finish time. This will cause issues for us when we

>co-treat/eval between PT and OT. Does anyone else do this and how have you

>handled the issue of cotreating with another issue? Thanks!

> Amory, St. Luke's Hospital

>

>

>