Learning “Opptie” #8

WE LOVE OUR THERAPISTS! AND, WE ARE PASSIONATE ABOUT LEARNING! Throughout the month of February, we are providing Learning “Oppties”. To learn more about the February Learning “Oppties” program, please read the introductory article posted January 31. Today’s Learning “Opptie” is related to the RAI Manual for MDS 3.0, v1.07, Chapter 3, Section O (manual can be found by going to cms.gov), rules on billing the different modes of treatment. As a reminder, the modes of treatment include Individual, Concurrent and group. Individual is defined as, “The treatment of one resident at a time.” Concurrent for Medicare Part A is defined as, “The treatment of 2 residents, who are not performing the same or similar activities, at the same time, regardless of payer source, both of whom must be in line-of-sight of the treating therapist or assistant.” And, Group for Medicare Part A is defined as, “The treatment of 4 residents, regardless of payer source, who are performing the same or similar activities, and are supervised by a therapist or assistant who is not supervising any other individuals.”

The Medicare Part B rules do NOT allow for recording at treatment as “Concurrent.” Instead, follow the Medicare Part B rule as such, “The treatment of 2 or more individuals regardless of two or more residents who may or may not be performing the same or similar activity, regardless of payer source, at the same time is documented as group treatment.”

Use the information above to answer the following “Opptie” challenge. Be sure to include your full name and facililty name on your response. Winners from this week will be posted on Monday, February 13. Good Luck!

  • An OT provides therapies that are not the same or similar to Mr. P and Mr. R at the same time for 57 minutes. Mr. P’s stay is covered under the Medicare SNF PPS Part A benefit. Mr. R’s therapy is covered under Medicare Part B. Based on the information above, how would the therapist record each patient’s treatment on the service log? Be sure to include “mode” and minutes.

6 thoughts on “Learning “Opptie” #8

    1. There’s no tricking you, baby! RIGHT ON! Medicare Part B does not allow “Concurrent” billing. So, any treatment with 2 or more patients at the same time would be “Group” for the Medicare Part B Patient. Thank you so much for your participation in Learning “Oppties”. Deb Bielek, Therapy Resource

    1. Excellent, Audrey! You’re in the know! Thank you so much for participating in our Learning “Oppties” program. You have been entered to win an award for this week’s participation. Stay involved and get your team on board! We also have team awards each week. Your answer is right on and thank you again for your participation in Learning “Oppties”. Hope to catch you in here again tomorrow 🙂 Have a great day. Deb Bielek, Therapy Resource

    1. Hi, Karin! you’re back and right on track! The challenge was to see if you identified the difference in billing and recording of minutes for a patient with Medicare Part B. What would be considered “Concurrent” for any other payor source, is actually “Group” for Medicare Part B. Mr. R was Medicare Part B, so your answer is correct. Thank you for participating in Learning “Oppties”. Winners for last week posted shortly. Deb Bielek, Therapy Resource

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