We have only initiated one Maintenance therapy case so far and that was billed to Part A under the client's skilled episode of care.  It appears that we can bill under the same skilled episode of care as long as the Therapist indicates and documents very clearly re: the need for ongoing maintenance services?

This prompted further discussion at a meeting this morning regarding initiating maintenance therapy for a different client, and whether the nurse needs to continue INR monitoring under the concurrent episode if there is no longer an identified skilled need for the nurse visits.  

I have been searching the internet this morning and found some information from the Jimmo Vs. Sebelius Settlement and  CMS Claims Processing Manual that appears we would bill for maintenance therapy services under the current skilled episode of care.  We would not be required to continue other disciplines if there is no skilled need identified for nursing services, etc. If a PTA or COTA is providing maintenance therapy services, there is a G code required for billing.  

I think the key is to provide very clear documentation to indicate when skilled is ending and maintenance services are beginning (new eval?) and justify how the skilled services of the PT are still required.  And then of course, review the margins.

 

 

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> on behalf of Jenifer Baker <jbaker@firstatmn.com>
Sent: Thursday, May 27, 2021 9:16 AM
To: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Subject: [EXTERNAL] Re: Maintenance Therapy