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PTA Blog Talk

Assistance Levels

Published May 28, 2014 10:12 PM by Jason Marketti

When we are documenting patient care and tracking progression of goals, we'll typically chart assistance levels and whether the patient required verbal cues as well as manual cues to complete a task. What if the assistance levels were eliminated from our documentation? Insurance companies would no longer be able to deny services because the patient wasn't meeting their goals based on our own documentation.

I wrote about how one PT eliminated goals for gait because certain insurance companies were discharging patients based on distances walked and not on function. If assistance levels are not documented, patients could no longer be denied services for lack of progress during therapy. The argument for this may seem illogical but with creative goal-writing, it's possible to keep patients on therapy who need the skilled services but would normally be denied by their insurance carrier because of a perceived lack of progress by a reviewer.

This may open up some departments to a fraud alert, however, there has to be an objective measurement that can be reached by the health providers during therapy. A standardized balance test could be used to justify services or strength testing could be used to track progress objectively. I'm not sure how this will play out in some departments since it seems like a new method to keep patients on therapy for a longer period of time. But so far I haven't heard of any therapists being called before a panel and questioned about its practice in patient care.

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You are right, if a therapist comes in as a PRN they will not know the previous level of patients function.  However, there are many times a patient will fluctuate in function based on who their therapist is on any given day.  

Also, patients who are confused can often fluctuate from SBA to total assist during a transfer in a matter of minutes.   One purpose of eliminating assistance levels in any documentation is to shield the patient from insurance reviewers who can deny services based on lack of progress in therapy.  

A heavily involved CVA may take several weeks of intense therapy for progression to show but an insurance carrier may want progress within a week.  

Jason Marketti May 30, 2014 7:02 PM

Sounds good bit how would one relay to others therapists what assistance a patient needs to perform certain tasks. I.e. SIT-STAND from w/c with Mod A oor maybe min a. From a prn stand point without that documentation one can't be properly prepared.

tyrell gentry, physical therapy - pta, S.P.O.R.T. PT May 29, 2014 12:01 AM
lewiston ID

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About this Blog

    Jason J. Marketti
    Occupation: Physical Therapist Assistant
    Setting: San Jacinto, CA
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