Reimbursement & Regulation
OPPT:
Functional Limitation Reporting under Medicare Part B -
begins Jan. 1, 2013: FAQ
from APTA
APTA webinar
with explanation of reporting.
One the acceptable tools for Functional
Limitation Reporting is "OPTIMAL"
(described below).
Designed
by the APTA, the Outpatient Physical
Therapy Improvement
in Movement Assessment
Log (OPTIMAL)
is an instrument that
measures difficulty and self-confidence in performing 21 movements that
a patient/client needs to accomplish in order to do various functional
activities.
|
October,
2012: Federal District Court rules Medicare will pay for services if
they are needed to “maintain the patient’s current
condition or prevent or slow further deterioration,” regardless of
whether the patient’s condition is expected to improve.
Robert Pear. Settlement Eases Rules for Some Medicare
Patients. New York Times. October 22, 2012.
Centers
for Medicare and Medicaid Services (CMS)
US Dept. Health and Human Services
1.
"Medicare
& You" (2021)
This is the pamphlet that is mailed to all beneficiaries each year. It
is in lay language and easy to follow.
Note: there are active links (blue font) within the pdf document for definitions.
- p.25: Part A coverage
- p.26: Part A, hospice
- p.27: Part A, hospital
- p.28: Part A, skilled nursing unit
- p.29-50: Part B coverage...
- p.40: Part B home health PT coverage
- p.43: Part B physical therapy coverage
2.
PACE: Program of All-Inclusive Care for the
Elderly
3.
Quality Evaluations by the CMS (Centers for Medicare and Medicaid
Service)
Hospital
comparisons
Nursing Home comparisons
Home
Health Agency comparisons
4. Physician Quality Reporting System (PQRS): a Medicare requirement for OPPT. Log on to APTA for the most current details.
5.
Medicaid
Missouri
Medicaid Basics "MO HealthNet"
published by the Missouri Foundation for Health, spring 2014
6.
There are two different federal programs related to disabled
and low income persons:
SSDI:
Social Security Disability Insurance
What
is it, and what are the Qualifications?
SSI:
Supplemental Security Income
What
is it, and what are the Qualifications?
Eligibility_Criteria_Documentation
7.
APTA - Defensible Documentation for Patient/Client Managment: "Documentation of a
Visit/Encounter"
8.
FIM: Terminology for Level
of Assistance for Functional Skills
10.
Part A: Admission
criteria for: SNF & for Inpatient Rehab Facility (IRF)
11.
Part A: Home Health:
- CMS
definition of homebound status (effective
11-19-2013)
- The
Outcome and Assessment Information Set: OASIS
documentation form used in Home Health.
(OASIS-C, version 2, October 2009)
12.
SNF: Medicare
coverage
13.
Rehab
Service Documentation
14.
Part A: Hospice Admission
Criteria
15.
Adult Day Connection: eligibility criteria
16.
Medicare B:
coverage of Therapeutic Footwear for people with diabetes
17.
DME (Kelly
DellaRocca PT, serves in an advisory capacity to a local pharmacy on
management of DME.)
18.
Veterans Administration: VA
Health Care Benefits
Q&A:
rehabilitation for veterans (V.
Knoll, personal communication 1-31-2012)
19.
ICD-10: Index to Diseases Version 2010
20.
Compare Health Coverage Plans
from various Insurance Companies
National Committee for Quality
Assurance (NCQA)
21. Physician
Owned Physical Therapy Services (POPTS)
22.
Missouri Practice Act
Missouri
Division of Professional Registration
... from the left-side menu, choose: "Physical Therapists/Physical Therapist Assistants"
... from the drop-down menu, choose: "Rules & Statutes"
... then choose "Statutes"
- Direct
Access (334.506)
- Continuing
Education Requirements (334.507)
- Supervision
of PTAs (334.650)
23. Directory of Services for Seniors
(pdf version, published by
the Senior Network, Boone County, MO)
Services for Seniors - Boone County Directory
(online version,
published by Daniel Boone Regional Library, Columbia MO)
Senior Citizens Handbook: Laws and Programs
Affecting Senior Citizens in Missouri
Legal Services of
Eastern Missouri. (2011). Senior Citizens Handbook: Laws and Programs
Affecting Senior Citizens in Missouri. 18th ed. Legal Services of
Eastern Missouri, Inc. and The Bar Association of Metropolitan St.
Louis. Retrieved 9-23-2013. http://www.mobar.org/uploadedFiles/Home/Publications/Legal_Resources/Brochures_and_Booklets/seniorcitizen.pdf
University
of Missouri
School of Health Professions
Department of Physical Therapy
Contact webmaster
Updated:December 8, 2022
|
|