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Toni Talks about PT Today

The Memo

Published November 12, 2007 1:57 PM by Toni Patt

I received a memo recently that reviewed guidelines for documentation on Medicare patients. It told us what to write to prevent denials. Anyone who has ever treated a Medicare patient is familiar with the word games we play with documentation. Medicare has its own language. Therapists have to learn the language and then learn how to use it. One wrong word or phrase and everything will be denied. All therapists were instructed to immediately alter how we document to fit the guidelines.

That part didn't bother me. It's what came next. We were also instructed to continue seeing only those chronic patients with a clear status change. That sounds like we're supposed to discharge the other Medicare patients as soon as possible. Many patients on Medicare are referred for therapy due to deterioration in functional status which usually develops over time from inactivity and worsening medical conditions. Unless they fall or require a hospitalization there isn't a clear cut onset date or event. These are the patients who are to be discharged.

Ranting against Medicare won't change anything. The APTA is fighting the reimbursement battle with them. Ranting against the facility won't help, either. Administration won't listen. Medicare didn't tell us to discharge these patients. Our administration made that decision. They looked at the bottom line and saw revenue loss from denied payments. They decided to do something about it. This is an extreme knee jerk response. Patients are costing them money so they must be discharged. While this may be good business sense, it isn't good for the patients.

This is scary. Patients are being denied care based on the assumption of non-payment. Taken to the extreme it could lead to no one accepting Medicare patients because they are afraid of not being paid or not paid enough. This has been happening with physicians for years. Therapists have been playing word games with Medicare for years to get payment for these patients. Medicare didn't change anything. My facility decided it was losing too much money and investigated. The memo is the result.

There are other options. Referral sources can be educated about correct language when making a referral. Therapists can be trained in Medicare documentation. A system can be put in place to monitor these patients and keep their treatment duration as short as possible. The problem is these solutions will take time to make an effect.


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