The Post-acute Care Guide to Maintenance Therapy

Medicare coverage for maintenance therapy in the post-acute world has been unclear, causing improper documentation and reimbursement for home health agencies, skilled nursing facilities (SNF), outpatient therapy, and rehabilitation facilities.

This guide contains both regulatory information and analysis as well as hands-on, practical advice for care and documentation. Advice given is specific to each post-acute care setting. The guide also features tips from consultants, tools from the Center of Medicare Advocacy and information from CMS, downloadable materials, and sample forms and worksheets for easy comprehension of information.

This book ensures Medicare coverage by:

- Guiding providers through the documentation process related to maintenance therapy
- Explaining how to document at key instances
- Tips for defending medical necessity
- Providing practical advice and information on how to identify patients who require maintenance therapy, conduct patient assessments, and write goals

After reading this book, readers will be able to:

- Understand the proper use of maintenance therapy
- Identify when and how to document care as maintenance therapy
- Determine which patients qualify as needing maintenance therapy
- Plan and assess care of maintenance therapy patients
- Document maintenance therapy with confidence
- Use the tools provided to help with comprehension and documentation

Table of Contents

Foreword

Chapter 1: Are We Providing Maintenance Therapy?

Chapter 2: Defining Key Terms

Chapter 3: Understanding the Regulations

Chapter 4: Identifying Maintenance Patients

Chapter 5: Assessments and the Maintenance Patient

Chapter 6: Goals Capturing the Impact of Therapy

Chapter 7: Care Planning With a Maintenance Focus

Chapter 8: Defending Medical Necessity on Routine Visits

Chapter 9: Reassessments in Maintenance Cases Mandatory and Clinically Driven

Chapter 10: Tips for Identifying Maintenance Patients

Chapter 11: Tips for Qualified Therapists

Chapter 12: Tips for the Quality Review Process

Appendices

This book contains tips, tools, and resources on:

- Identification of maintenance candidates
- Goal writing strategies
- Compliance with reassessment expectations
- Care planning for the maintenance patient

Also included:

- Documentation auditing tool

Judith Stein, a lead attorney on the Jimmo v. Sebelius case and executive director for the Center for Medicare Advocacy, has provided tools to help agencies better use maintenance therapy in their practice, including a Self-Help Packets for Home Health Care/Outpatient/Nursing Appeals, Including 'Improvement Standard' Denials.

A specific scenario is used throughout to demonstrate key concepts. To enhance knowledge application, a practice scenario is provided as well.