Physical Therapy- New rules for Documentation, or Not

Seen the OIG 2007 Work Plan?

If you are a homecare agency that provides rehab..and who doesn't?..better check out the OIG's plans for next year. Here's the gist:

• OIG wants to check on the expansion of focus on therapy services in homecare
• Get more specific on "reasonable and necessary"

Generally, the therapists will need to do more to justify the need for therapy. Documentation for high therapy threshold cases will have to support a clear need- not the need for rehab, the need for the number of visits planned.

How do you do that?

Therapy goals MUST be tied to function.
The treatment plan must explain why a therapist is needed, not just a trained family member
The diagnosis must support the plan
And daily notes must justify all the above

If you have ever thought about having a rehab supervisor, now's the time. Nurses reviewing therapy justification of this caliber might not catch problems. How about sharing examples of lingo that would do the trick?

Got denials?

• Patient feels more comfortable
• Patient has no complaints
• Patient is progressing well
• Patient walked 50 feet
• Patient is tolerating the HEP well
• "Independent" with goals

An automated clinical documentation system can provide the cues to make sure the statements necessary to justify rehab therapy are complete under the new regs. This means the system must reach to the point of care. Therapists are often contractors. This presents a special challenge to home health agencies who have to figure out how to equip contractors with laptops or other technology. Some agencies provide contractors with web access to the documentation system while others issue laptops to all on the professional staff, regardless of employment status. Otherwise, the therapy group must provide its own automated documentation system in order to control the quality of documentation in support of new rules for 2008.