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Following PPS Guidelines for Reassessments in Home Health

Diana L Kornetti, PT, MA, HCS-D, COS-C, Kenneth L. Miller, PT, DPT, GCS, CEEAA

November 29, 2012

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Question

Can you please review the required assessment and reassessment dates as well as who can perform them?  

Answer

The required reassessments are at therapy visit numbers 13 and 19.  If multiple services are involved, at this point, guidelines state that it should be close to [the 13th and 19th visits]. So in other words, if PT and OT are both in a home, then we are working on the range of 11 - 13 and 17 - 19.  Now, that will be further defined - and clearly defined - for multiple therapies in the upcoming finalization of the PPS 2012 rule.  The 13th and 19th visits are therapy counts (the counted number of total visits for all disciplines together) and are episode specific.  When we start a new episode of care, we start that count again.  

We also have a 30 day reassessment.  The 30 day reassessment means that we should not go greater than 30 days from our last assessment without reassessing the patient.  In other words, if we evaluate the patient on day 1 of the episode and do visit 13 on day 22, we don't have to go back out and do a reassessment by day 30.  Day 22 was the reassessment.  We reset the reassessment clock at that point, and now we have until day 52 to go back out and reassess that patient.  

The 30 day reassessment is not episode specific.  The biggest discrimination between the two is that 13 and 19 are visit count episode specific.  They start over with a new episode or a new 60 day period of care.  The 30 day is a continuing count.  As long as you have that person on your service, you cannot go greater than a 30 day period of time without a reassessment for all of the disciplines that are in.  

Who must do them?  Medicare calls it a qualified therapist. That's doesn't mean assistants are unqualified, it just means that they want an evaluating therapist to do them - a PT, OT or SLP.  Assistants are unable to do the mandatory reassessments.

 

 


diana l kornetti

Diana L Kornetti, PT, MA, HCS-D, COS-C

Dee, a physical therapist for 30 years, is a past administrator and co-owner of Integrity Home Health Care, Inc. – a locally owned and operated Medicare-certified home health agency. Dee now provides training and education to home health industry providers through a consulting business, Kornetti & Krafft Health Care Solutions, with her business partners Cindy Krafft and Sherry Teague, where she serves as its Chief Operations Officer.  Dee is nationally recognized as a speaker in the areas of home care, standardized tests and measures in the field of physical therapy, therapy training and staff development in the home health arena. Dee is the immediate past Editor of the Quarterly Report, a publication of the  American Physical Therapy Association’s (APTA) Home Health Section , as well as member of the Home Health Section’s Practice and Education Committees.  She currently serves the Home Health Section as its Program Chair for annual conference educational activities.  She has been an active member in good standing in the APTA since 1986.  She is also the President of the Association of Homecare Coding and Compliance, and a member of the Association of Home Care Coders Advisory Board and Panel of Experts.  Dee is a published researcher. You can find her research on the Berg Balance Scale. She has also co-authored Home Health Section resources related to OASIS, goal writing and defensible documentation for the practicing therapist.Dee received her B.S. in Physical Therapy from Boston University’s Sargent College of Allied Health Professions, and her M.A. from Rider University in Lawrenceville, NJ. Her clinical focus has been in the area of gerontology and neurological disease rehabilitation. 

 


kenneth l miller

Kenneth L. Miller, PT, DPT, GCS, CEEAA

Dr. Ken Miller, PT, DPT, is a board-certified geriatric clinical specialist and advanced credentialed exercise expert for aging adults. Dr. Miller is an assistant professor at the Medical University of South Carolina in the Division of Physical Therapy and serves as the founding director of the USC Geriatric Residency Program. His clinical focus is on best practices for use with the older adult population. Dr. Miller is the Director overseeing Practice for the Academy of Geriatric Physical Therapy. He has spoken nationally and internationally on topics of gerontology, including pharmacology, primary prevention, frailty, outcome measures, best practices, and pain management for the older adult.  Dr. Miller has over 20 years of clinical expertise in risk mitigation and error prevention and is currently researching well-being, mental health, and burnout in physical therapists.  

 


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