Have you seen any Medicare payment denials when the patient moves in and out of hospice and/or palliative care and is being treated by physical therapy?
Answer
If a patient left hospice and then came back into palliative care, as long as the documentation can justify why skilled therapy services were needed, there should be absolutely no issues with insurance denials. This is because according to the Jimmo versus Sebelius settlement, as long as it's skilled therapy services are needed to maintain or slow the decline, then it(physical therapy) should be appropriate.
Chris Wilson, PT, DScPT, DPT, GCS
Chris Wilson PT, DPT, DScPT is an Associate Professor and Director of Clinical Education in the Physical Therapy Program at Oakland University in Rochester, Michigan, and was the founding Residency Program Director for the Beaumont Health Oncology Residency, the first accredited residency program for physical therapists in the United States. His clinical focus is Acute Care Oncology and Palliative Care. He is active in clinical research in the areas of Oncology, Hospice/Palliative Care, and Geriatrics. Dr. Wilson received his Doctor of Science from Oakland University. He received his transitional DPT from the University of St. Augustine with a Primary Care Certification and his Masters in PT from Oakland University. He has been Board Certified as a Geriatric Clinical Specialist since 2008. Chris has been awarded the Flomenholft Humanitarian Award from the Academy of Oncologic Physical Therapy in 2022 and the Signe Brunnström Award for Excellence in Clinical Teaching in 2015 from the American Physical Therapy Association. Dr. Wilson is a prolific writer and researcher. He published the book entitled Physical Activity and Rehabilitation in Life Threatening Illness by Routledge in 2021 and is the co-editor of the forthcoming textbook entitled Oncology Rehabilitation: A Comprehensive Guidebook for Clinicians to be released by Elsevier in Fall 2022. He has published over 35 full-length peer reviewed articles and many invited publications. Chris was the primary author and sponsor of the APTA’s positions on hospice/palliative care, diet and nutrition, and medical necessity in the presence of declining conditions.
Related Courses
1https://www.physicaltherapy.com/pt-ceus/course/palliative-physical-therapy-in-home-4460Palliative Physical Therapy in the Home: Core Concepts for SuccessPatients with life limiting conditions and late-stage chronic diseases experience dramatic fluctuations in function and physical status which negatively affect their quality of life. Physical therapists are well positioned to mitigate these functional and quality of life issues through strategic and skilled delivery of their interventions and education in the home setting.auditory, textual, visual
Patients with life limiting conditions and late-stage chronic diseases experience dramatic fluctuations in function and physical status which negatively affect their quality of life. Physical therapists are well positioned to mitigate these functional and quality of life issues through strategic and skilled delivery of their interventions and education in the home setting.
2https://www.physicaltherapy.com/pt-ceus/course/oasis-e-new-items-4612OASIS E: New ItemsThe course will focus on the items that are unique to the OASIS E data collection process. Official guidance sources will be explored to ensure the accuracy of the information.auditory, textual, visual
The course will focus on the items that are unique to the OASIS E data collection process. Official guidance sources will be explored to ensure the accuracy of the information.
3https://www.physicaltherapy.com/pt-ceus/course/mindfulness-beyond-guided-meditation-3902Mindfulness: Beyond Guided MeditationMindfulness can be a really powerful cognitive-behavioral tool and has many relevant applications when treating patients with pain, especially chronic pain. Many courses for rehabilitation professionals teach guided meditation, which is an amazing tool. However, mindfulness has many other applications and opportunities for use in the treatment of patients with pain. This session discusses the history and science behind mindfulness, as well as provides a variety of practical mindfulness tools for the everyday practitioner. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.auditory, textual, visual
Mindfulness can be a really powerful cognitive-behavioral tool and has many relevant applications when treating patients with pain, especially chronic pain. Many courses for rehabilitation professionals teach guided meditation, which is an amazing tool. However, mindfulness has many other applications and opportunities for use in the treatment of patients with pain. This session discusses the history and science behind mindfulness, as well as provides a variety of practical mindfulness tools for the everyday practitioner. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.
4https://www.physicaltherapy.com/pt-ceus/course/diabetes-in-adults-current-guidelines-3958Diabetes in Adults: Current Guidelines and EvidenceThis course gives us an overview of diabetes in adults, discusses current perspectives and guidelines, and addresses its significance in PT practice. It also looks at some of the current literature that addresses the evidence for risk factors and interventions and to see how they may apply to our practices. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.auditory, textual, visual
This course gives us an overview of diabetes in adults, discusses current perspectives and guidelines, and addresses its significance in PT practice. It also looks at some of the current literature that addresses the evidence for risk factors and interventions and to see how they may apply to our practices. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.
5https://www.physicaltherapy.com/pt-ceus/course/trauma-informed-care-principles-for-3975Trauma Informed Care Principles for Rehabilitation ProfessionalsAcute and chronic trauma is very prevalent in the United States, and have been tied strongly to adverse health behaviors and outcomes. This course provides the rehabilitation professional with an overview of the physiology of trauma, as well as practical tools to work with patients who are experiencing trauma. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.auditory, textual, visual
Acute and chronic trauma is very prevalent in the United States, and have been tied strongly to adverse health behaviors and outcomes. This course provides the rehabilitation professional with an overview of the physiology of trauma, as well as practical tools to work with patients who are experiencing trauma. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.
