Medicare Caps
Therapy is once again taking a hit with the passing of the
Part B Caps which took effect on July 1, 2008. Congress allowed the bill to take full effect as originally scheduled several years ago. These Caps have been held off in the past by Congress signing bills to delay enactment. This year, it seems like there wasn't time in their schedule to debate it, so it simply got voted to be enacted. No further discussion regarding the bill will happen until after the July holiday.
In the meantime, we have to begin tracking on all Medicare Part B residents. The $1790 cap on Occupational therapy can not be exceeded, and if you do you won't be paid for it. This means accurate and frequent checking of books and schedules to keep aware of each persons limit. This multitude of time we spend tracking and documenting on a Part B patient, however, is not billable.
The main issue though, is the residents. If someone needs therapy, there should be no question of if they can receive it. If we see a resident in need, we are required to address it. If we have to address therapy problems, but not get paid for doing so, how long will it be before either the company goes broke or the Part B residents are ignored further? I see this similar to having a doctor diagnose you with a curable disease, but then not being able to give you the medicine because you've already spent your limit.
The first year the Part B Caps were in effect, I had a resident who exceeded their cap by April of the year. Suffering from a series of TIA's, the scenario was always the same; have the mini-stroke, be sent to the hospital, kept for 1-2 days, then be sent back to the SNF needing a bit of therapy to regain their skills. Since the hospital stays were never long enough to qualify for Part A benefits, the cap was met quickly. This person did well throughout much of the rest of the year, but then in late November another light CVA. The hospital was full at the time with a local virus increasing admits, so the person was sent back to the SNF after 2 ½ days. Their cap long exceeded, and unable to pay privately, all the home would allow is an eval to establish a restorative program.
Business being business I can understand that when all you look at is numbers, the decision for not providing therapy to someone who has exceeded their cap is the only answer. But what we need to remember is what we are talking about: people.
Until next time, hope all your thoughts are good,
Tim
*Note from editor:
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