During one of our webinars entitled ‘Audit-Proof your Skilled Therapy Documentation‘, our speaker and course author, Lisa Milliken, M.A., CCC-SLP, conducted a LIVE Q&A with the attendees. Below is a compilation of just a few of the interactions which took place following the webinar:
Q: What is a UB-04?
A: A UB-04 is the electronic billing document that is submitted from the business office manager to the Medicare office for payment. It is basically an itemized list of therapy CPT codes/services provided, per day, and per discipline. The supporting medical diagnostic codes (ICD-10s) are listed near the bottom of the form. These codes are significant for supporting the fact that skilled therapy services were needed.
Q: Can you please give some examples of documentation that shows the unique skill of a therapist in a maintenance scenario?
A: There is a great list of suggested skilled terminology to use for different clinical scenarios on the ASHA website.
Basically, you want to show the reviewer that you are using your professional skills to teach/train the patient and the caregivers/staff, with your skills, which no one else could teach. Your skills are proven through your documentation with active skilled verbs such as: “instruct,” “analyze,” etc. Some examples listed on this site are:
- Instruct patient and caregiver in use and care of communication system.
- Develop maintenance program—to be carried out by patient and caregiver—to ensure optimal performance of trained skills and/or to generalize use of skills.
- For patients with chronic or degenerative conditions, evaluate patient’s current functional performance; provide treatment to optimize current functional ability, prevent deterioration, and/or modify maintenance program
Q: How long do we have to write the discharge notes?
A: It is preferred by Medicare that the DC note is written the same day, but sometimes that is not possible, so it should be written as soon as possible, following the discharge. That may sound vague, but that’s exactly what a Medicare reviewer told me once as well.
Q: What is the point of a soap note (an acronym for subjective, objective, assessment, and plan)?
A: Soap notes are often used in the hospitals/acute care, but not required at the post-acute level. It’s a good format when companies or hospitals require progress notes, but not required.
Q: To clarify regarding Part B billing when supervising students, can I not bill Ultrasound if the student performs it while I’m observing and giving instruction to the student throughout the treatment?
A: Student supervision of Part B includes very specific requirements, so that EITHER the Therapist OR the supervised student can bill, with the therapist is supervising at 100%. So the treatments provided (ultrasound or other modalities) will be billed by the supervising therapist, whether they, or the student performs the service.
Q: Why is the difference in supervision level for students being line of sight for Part B Medicare, versus distant in clinic?
A: So, Medicare gives very specific guidelines on Part A vs. Part B, as of January 1, 2012. We can now use our professional judgment of the student’s skills for Part A, as long as we are in the building; but we must supervise at 100% level for Part B, meaning we cannot be doing anything else if we are supervising a student with a Part B pt… That’s just the Medicare rule.
Q: I have remembered Exclude 1 and Exclude 2 in ICD-10 coding, but I completely forgot the codes that have those exclusions, I’m wondering if you could elaborate on this.
A: ICD-10s have these “exclude codes” per diagnostic section of the ICD-10 manual. You can easily look them up, or I’ll be happy to look them up and email them to you for a certain coding section.
Q: Is it necessary for PT to indicate tx. time, do progress notes and functional limitations on the 10th visit for a Med B patient? What if it was missed? Can it be done the next visit?
A: That’s 2 different issues. If you missed a progress report on the 10th visit, then complete it as soon as possible and de\scribe the circumstances why it was missed; then you should be ok. Then, regarding the G-codes, document the next functional G-code as soon as possible and let your billing person know that it was completed.
About Lisa Milliken, M.A., CCC-SLP:
Lisa Milliken, M.A., CCC-SLP has served 27 years in multiple clinical and corporate positions in the healthcare industry. She is currently the Corporate Education Coordinator for Windsor Rehab, serves as the TX State Medicare Administrative Contractor (SMAC) Representative, has presented over 60 courses at the state, regional and national levels, including 10 years at annual ASHA conventions. She has recently served as the LSHA Board President and was a member of the Council of State Association Presidents (CSAP) and now serves on the TSHA Executive Council. Her clinical specialties include dysphagia and dementia management and she is also a recognized speaker/teacher in the areas of Medicare Regulatory affairs as well as documentation, denials/appeals and leadership in healthcare.
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