Another topic to touch on that is spoken about all over and nothing is seems to be done about is "minutes".  When did we go into this profession to max out our patients 100 days and to push 75+ minutes per day whether they can do anything or not.  I have seen and experience the effects of manangement pushing to get our minutes with each patient so that our productivity is high and that our buildings RUG category is also at its highest.  There have been patients who actually sit for 30 minutes choosing to not continue or unable to, yet are being billed the entire time because we need to reach a certain amount.  The focus seems to be the minutes rather then the care and quality of care to the patient.  How did this happen and why is it not being changed, I would think most would agree that this is not what we went into this profession to do, we went in to it to make a difference in someones life who needs it.  Not to bill the heck out of them and make myself look good on paper with numbers.  What can be done to stop this.

Charging for patients sitting around is medicare & insurance fraud, and putting your profesional license at risk.

This is a very true statement.  I don't know if there is a clear solution to this problem.  I did what I needed to do to keep my license and to keep myself ethically sound in this profession.  I no longer work in nursing homes where this fraud occurs.  It happens alot in many, many different types of facillities.  I work in home health where RUG levels are not an issue and I can still provide the best care I can for the pt.  You do have the choice to contact Medicare in your state about this issue (which is anonymous) and report this practice if you wish.  I can verify and so can many others that visit this forum, that this happens all over.  Healthcare has now become about making the most for "the bottom line".   Nursing homes are classic for this practice.  It is a tough road to go down.  Good luck with this endeavor.  

I wanted to give my 2 cents on this topic. As an OTR and Director of Rehab at a 100 bed SNF, I have never asked my therapists to bill for more time than they actually do with the patient. Some patients get 75 minutes per day and some get 30. In my building, the amount of treatment time provided and billed depends on what the patient needs and can tolerate.

In my opinion, the stigma that surrounds nursing homes will only get worse with therapists saying that it improper billing is "classic" in this setting. You must understand that there are bad apples (therapists) in all settings. LTC is one of the major practice settings for OTs/COTAs and by making these type of statements indicating that Medicare and insurance fraud is being done will only send a gray cloud over our profession as a whole.

I could make the generalization that home health therapists are only concerned about the "visit" and not the care (or) time it takes because they are paid a flat fee for each visit completed. While this may be common, I know that this is not the case for all home health therapists and I would never make this type of generalization.

 The point that I am trying to make is that it is up to you to stand up for yourself and follow the state and national practice guidelines for patient care and billing. Its your license on the line. If all therapists would stand up for themselves then the focus on the minutes would decrease and the focus of care would be brought back to the forefront where it belongs.

I always do what is right for the patients, whether or not the manager agrees with it, I do what is right.  If more people did what is right, we would not be heading for PPS II at the rate it is going.  I do have pressure from our rehab director to get the minutes in but I only report what is actually billable.  I worked too hard to get my OTR and do not want it jeopardized by some manager pressuring me for billable minutes.

So well said! 

I would suggest you go to work for someone else.  It's not like that everywhere.   

I am a new grad/entry level OTR so this is very helpful... and i will be starting in a LTC/SNF too so its good to know we do have a choice.. no matter what the DOR says about "minutes".

I dont know about a choice so much, we are told if you dont get all of your minutes then to tell the super and she/he will go back and get the rest later that day or the SLPs will increase their times.  It is unbelievable, one way or another they will get it so they can be on top.  crazy system!