News & Blog
Quick Tip for Meeting Home Health Therapy Requirements

Posted on April 18, 2011 in Education Featured-writers 

by Jennifer Warfield, RN, BSN, HCS-D, COS-C
Education Director, PPS Plus Software

The new home health therapy reassessment requirements contained in the Calendar Year 2011 Final Home Health Rule became effective April 1. Is your home health agency prepared to meet these requirements?

Plan for more assessments & establish shorter goals
In addition to the long-standing requirement that each therapy patient be seen by the licensed therapist at least every 30 days, the 2011 Final Rule has even more stringent requirements. Minimal requirements for this regulation require that any time a patient has more than 13 therapy visits scheduled, and any time the patient has more than 19 therapy visits scheduled, the qualified licensed therapist (not an assistant) must reassess the patient before that 13th and 19th visit. (Keep in mind that the 13th and 19th therapy visit time points relate to the sum total of therapy visits from all therapy disciplines (PT, OT, and ST.) For patients being seen by more than one therapy discipline past the 13th visit or 19th visit, all continuing therapy disciplines must reassess the patient before the 14th (or 20th) visit, as close to the 13th or 19th target visit as is practically possible.

After review and reconsideration of the proposed rule, CMS granted some reprieve to agencies in RURAL areas (defined by CBSA codes) or for those where a situation outside of agency's control arises and a visit on exactly the 13th or the 19th visit is not possible. An allowance was made that a visit could be done after the 10th visit but not after the 13th or after the 16th but not after the 19th. This means that home health agencies must account for more frequent reassessments from each qualified therapist to justify the need for more therapy visits.

Proper planning is vital to an agency's success with this Final Rule. When you look at your goals today, they are long-term goals for the entire 60-day episode of care. With the new therapy requirements, you must show progress on the 13th and 19th visits. The key to compliance is to establish shorter goals when you do your original assessments.

When you complete a patient's original assessment, do not establish goals based on the patient's entire 60-day episode of care since it is very possible that a reassessment would be long-before the next recertification assessment is completed. Just as you may establish a goal that a stroke patient will be walking 150 ft within 60 days when he or she might actually get there in 30 days, plan for more frequent reassessments beginning April 1 and establish shorter goals.

How is your agency preparing to meet these new therapy requirements? Do you have any questions? Please submit your questions and comments here!

©2011 PPS Plus Software. All rights reserved.

About the author:
Jennifer Warfield RN, BSN, HCS-D, COS-C, is the Education Director at PPS Plus Software and an informational ally for hundreds of home health agencies across the country. As a homecare coding specialist, OASIS specialist and registered nurse with 30 years of clinical and management experience, she frequently conducts online and on-site educational workshops and is a regular guest speaker at numerous home care conferences.

Comments
  1. Do you anticipate more therapy cases discharged at the 13 day reassessment visit

    By Nancy Beck on Apr 18, 2011 at 02:13 pm

  2. While there is nothing in the Final Rule that would suggest that fewer patients would need more than 13 visits

    By Jennifer Warfield on Apr 18, 2011 at 02:36 pm

  3. Continuation from above…?Unfortunately

    By Jennifer Warfield on Apr 18, 2011 at 02:37 pm

  4. We have received conflicting information regarding the 30-day evaluations in relation to the 13th and 19th visits. I have understood that the “30-day clock” for each ordered discipline resets with an evaluation on the 13th and/or 19th visit. One reference states the 30-day therapy eval for each discipline is due based on the initial therapy visit

    By Kathy Hamilton on Apr 27, 2011 at 01:24 pm

  5. From the Official CMS Therapy Requirement Fact Sheet: “The 30 day clock begins with the first therapy visit (of that therapy) and the clock resets with each therapist’s visit/assessment/documentation (of that discilpline).”

    By Jennifer Warfield on Apr 28, 2011 at 08:00 am

  6. If a patient has therapy in previous cert

    By Sheila on May 03, 2011 at 10:45 am

  7. The reassessment at visits 13 and 19 are effective for each cert period but the 30 day reassessment can span more than one cert period.  In your scenario

    By Jennifer Warfield on May 03, 2011 at 12:57 pm

  8. For the new 30 day therapy rule

    By Sheila on May 04, 2011 at 01:17 pm

  9. Does the therapist have to do an actual evaluation on the 13th and 19th visit or is there a form that is used?

    By Christy B. on May 09, 2011 at 02:07 pm

  10. they do their regular note

    By Sheila on May 10, 2011 at 12:09 pm

  11. Because Louisiana has more stringent laws governing PT visits - the PT sees more frequently than 30 days.  Does each time the PT does a evaluation start a new 30 day count?  Also, does the 30 day count start over with each new episode?

    By Joyce Huntington on May 11, 2011 at 07:10 am

  12. I am so confused with so many write-ups and just wanted to clarify. Patient A has a start of care
    4/4 with a PT Eval on 4/6 and OT eval on 4/8.
    PT did the re-assesment on the 11th visit on 4/21 and OT did theirs (12th visit) the same day. Then they did the 18th and 19th visit on 5/5 and 5/6 respectively. When is the 30 day rule going to come in? Certification Period is 4/4-6/2.

    By Rod Zshornack on May 26, 2011 at 11:13 am

  13. The 30 day reassessment requirement states that a reassessment must be done at least once every 30 days and can span two episodes of care. In this scenario, the 30 day requirement starts over every 30 days for each discipline (from 4/6 for PT and 4/8 for OT). Both disciplines have already met the 30 day requirement. The reassessment requirement for the 13th and 19th visit does not apply until another episode starts.

    By Jennifer Warfield on May 26, 2011 at 02:05 pm

  14. How are home health agencies keep track of these re assements ?

    By Lisa on Jun 14, 2011 at 07:31 pm

  15. patient was admited 4/4 after 13th and 19th visit what do we do?

    By cecilia sanchez on Jun 20, 2011 at 02:54 pm

  16. Cecelia,
    What I am reading is that this patient was admitted on 4/4 and the therpaists have completed their 13th and 19th visit reassessments. What vist requirement is next? The requirement for reassessmet at the 13th and 19th vists restarts with the next certification period. But there is also a requirement that each patient must also have a reassessment at least once every thirty days and at that time the clock restarts for the next thirty days.

    By Jennifer Warfield on Jun 22, 2011 at 11:59 am

  17. Does the therapy reassessment requirement for combined PT/OT visits that ends with a discharge by the PT on the 12th visit and OT on the 13th visit still apply?
    Thank you,
    Sincerely,
    Jackie Porter

    By Jackie Porter on Jun 24, 2011 at 01:46 pm

  18. IF there are more than 13 combined therapy visits scheduled and both disciplines discharge before the 14th visit, the reassessment no longer applies. On the other hand, if one discipline simply cancels or skips a visit for any reason with the intent to reschedule, the reassessment will still apply.

    By Jennifer Warfield on Jul 01, 2011 at 09:10 am

  19. in a new admit(with only pt) the reassessments would be 13th and 19th visits and the 30th visit also? then the next reassessment would be 30th visit after that? then the next recert the 13th 19th reassessment starts over?  am cofused

    By Darcie on Jul 12, 2011 at 06:02 pm

  20. In a new admit, the requirement is for a reassessment at visits 13, 19 and every 30 days.  The 13 and 19 visits are per assessment but the 30 day requirement crosses into next cert period.

    By Jennifer Warfield on Jul 14, 2011 at 08:12 am

  21. What happens in this scenario: a total of 14 visits are made by PT and OT. the OT’s last visit and discharge is visit #11, and the PT’s final visit/discharge is visit 14th.Since the OT discharged 12 days prior to the PT’s final visit, will OT still be required to submit a re-assessment?

    By Jackie Porter on Jul 14, 2011 at 11:00 am

  22. IF Patient came back from hospital and resumption of care was completed followed by the reeval, and 13th visit fall right after 2 visit, do we still have to reassessment on the 13 visit?

    What if we are discharging patient on 13 or 19th visit?

    By Sukh Kaur on Jul 25, 2011 at 06:49 pm

  23. back to question#19..the reassessment is the 13 and 19 visits and 30day. the every 30day reassessment continues into the next recert and every 30 days thereafter until therapy is d/c? the only time for the 13 and 19 visit reassessment is new P.t. admt? is this right? another question: in a post hosp .(roc) and u had 4 P.T. visits before patient went into hosp then the reass was done when patient came out do u keep counting..as the reassessment visit would count as visit 5 and then the next reassment.
    would be 13th visit and so on?

    By Darcie on Jul 25, 2011 at 08:07 pm

  24. 14 total visits were made by PT & OT. The OT saw the patient for a total of 4 visits (PT saw pt for 10 visits) and discharged the patient 2 weeks prior to the last PT visit. The PT did a re-assessment on visit 13, would the OT still have to do a re-assessment even if they were no longer on the case?

    By Jackie on Jul 26, 2011 at 09:16 am

  25. If a patient was transferred to hospital and a Resumption of Care was done, including PT/OT re evaluation, does the “clock” reset, for total visits or continued from the initial rehab evaluation? Thank you!

    By Ellen Slotnick on Jul 26, 2011 at 01:52 pm

  26. Darcie,

    The requirement for a reassessment every 30 days continues as long as a patient is on that therapy service and can cross into a new cert period. The 30 day clock resets each time there is a qualified therapy reassessment done.
    The requirement for a visit prior to the 14th or 20th is per episode and does not cross into a new cert period.

    When a reassessment is done for a ROC, the 30 day clock resets with that visit but the 13 and 19 visit requirements continues, therefore the ROC would be visit #5.

    By Jennifer Warfield on Jul 26, 2011 at 02:31 pm

  27. Sukh,

    The 13 and 19 visit requirement is per episode so in this case if the ROC is counted in addition to the visits made prior to rehospitalization. If visit 13 or 19 are discharge visits, no further visit is required as the rule is for episodes with greater than 13 or 19 visits.

    By Jennifer Warfield on Jul 26, 2011 at 02:33 pm

  28. Jackie,

    No. In this scenario, only the PT is required to do a reassessment.

    By Jennifer Warfield on Jul 26, 2011 at 02:34 pm

  29. Please Clarify: If the 19th visit is a discharged visit, then a re assessment is not required? In ROC, the 30 day reassessment is reset but not the 13th and 19th visit. So, even if the patient had 10 visits prior to being transferred to the hospital. And PT re evaluates, as visit #11 and OT re evaluates as visit #12, both clinicians must re evaluate?

    By Ellen Slotnick on Jul 26, 2011 at 02:54 pm

  30. clarify #16/#26 answers. if P.T. continues thru 3 recerts with each new recert you start the 13 and 19 count? but starting with the 1st cert you count 30 days from P.T. first visit for the 30 day reassessment and 30 day clock resets with each reassessments so the 30 day count can carry on thru the 3 recerts or carry on and on until therapy is d/c. is this correct?

    By dacie on Jul 26, 2011 at 08:27 pm

  31. Ellen,

    If there were more than 19 visits scheduled, a reassessment must have been completed prior to the 14th visit. But, if the patient was discharged on visit 19, no other reassessment is required because the requirement if for visits greater than 19. After a ROC assessment, that visit factors into that cert periods total visits.  Therefore if the total # of visits is greater than 13 or 19, the reassessments would be required by those two visits.  The ROC assessment is considered a reevaluation and the clock resets from that date for the 30 day requirement.  Keep in mind that the requirement for a re-eval is continuous as long as the patient is on service and the clock resets WHENEVER a new re-eval is done (includes the re-evals at visits 13 and 19).

    By Jennifer Warfield on Jul 28, 2011 at 10:04 am

  32. If the 13th OT visit is also discharge for OT does OT need to do d/c and 13 day reassessment ornjustnthendischarge.

    By Rosemarie Byers on Aug 09, 2011 at 05:23 pm

  33. Can you tell me where I can get a listing of rural areas in Texas for home health therapy?

    Thank you,

    By Betty on Aug 11, 2011 at 01:33 pm

  34. So does the recertification of therapy for the next cert period doesnt count toward the 30 day assessment? For example, if the 30 day assessment falls the day after the patient is recertified for therapy, the therapist has to do another evaluation, the recert doesnt count?

    By Ashleigh on Aug 25, 2011 at 08:10 am

  35. If a patient returns from a previous d/c or hospitalization on the same cert period and the eval/re-eval done is the 12th visit, does the PT have to go back and do the functional reassessment for the 13th visit or is the 12th visit close enough?

    By Diana on Aug 25, 2011 at 03:18 pm

  36. IF THE 13TH VISIT IS ALSO A DISCHARGE VISIT DOES THE THERAPIST NEED TO COMPLETE THE REASSESSMENT OR CAN THE ASSISTANT COMPLETE THE DC?

    By ANNA RODRIGUEZ on Sep 01, 2011 at 09:16 am

  37. Anna,

    The reassessment requirement is for episodes with greater than 13 visits.  Therefore, if the discharge visit is the 13th visit, only the discharge assessment is required. Regarding who can perform this visit, follow your state regulations.

    By Jennifer Warfield on Sep 01, 2011 at 02:27 pm

  38. Ashleigh, the recertification assessment is considered in the every 30 day assessments.  Any re-eval (13th, 19th, recert or ROC) resets the 30 day clock.

    By Jennifer Warfield on Sep 07, 2011 at 11:03 am

  39. Diana,
    The evaluation on the 12th visit would count and the 30 day reassessment clock starts over from that visit.

    By Jennifer Warfield on Sep 07, 2011 at 03:02 pm

  40. WHEN THERAPY IS BEING ORDERED AND THERE IS ONLY 2-3 WKS LEFT IN THE EPISODE, CAN YOU ADD ADDITIONAL VISITS ON EVALUATION FOR NEXT CERT PERIOD?

    By ANNA R. on Sep 13, 2011 at 08:45 am

  41. Anna,
    If you add therapy visits during an episode, they are considered for that episode unless they are added during a recertification in the last 5 days of the episode. In that case, the visits apply to the next episode.

    By Jennifer Warfield on Sep 13, 2011 at 11:43 am

  42. A pt is being seen by S.T. and P.T. The S.T. completed a 30 day reassessment(included the reassement for the 17th visit) on the 16th visit. Is this acceptable under medicare guideline to be considered as both 30 day & reassessemnt since it was completed before the 19th visit?  Can the 17th - 19th reassessment be completed anytime between 15-19?

    By ANNA R. on Oct 14, 2011 at 09:59 am

  43. Anna,
    If the assessment was done on the 16th visit it will not qualify as the guideline specifically states “after the 16th visit”.  See below for the documentation from the Therapy Requirement Fact Sheet from CMS. Click here for a copy of the Fact Sheet: https://www.cms.gov/HomeHealthPPS/Downloads/Therapy_Requirements_Fact_Sheet.pdf


    “When the patient resides in a rural area or when documented circumstances outside the control of the therapist prevent the qualified therapist’s visit at exactly the 13th visit, the qualified therapist’s visit can occur after the 10th therapy visit but no later than the 13th visit. Similarly, in rural areas or if documented exceptional circumstances exist, the qualified therapist’s visit can occur after the 16th therapy visit but no later than the 19th therapy visit.”

    By Jennifer Warfield on Oct 14, 2011 at 10:58 am

  44. are the requirements for p.t. and o.t. reassessment (13th ,19th, and 30 day) made by each therapy. example does p.t. do one for p.t and o.t. does one for o.t….....also how often are supervisories for lpta, cota required?

    By darlene on Oct 28, 2011 at 07:14 am

  45. Darlene, Requirements for reassessments are per discipline.  If all 3 disciplines combined equals more than 13 or more than 14 visits, they must each do a reassessment.  As for the supervisory visits, different states have different rules.  Please check your agency and your state rules for those.

    By Jennifer Warfield on Oct 28, 2011 at 07:41 am

  46. if each therapy does reassessment for combined # of visits how does each dicipline (p.t./o.t.) know how many visits the other has made to be able to do reassements in the right time frame?

    By darlene on Oct 28, 2011 at 08:16 am

  47. I am aware of the need to “remove” visits if the 13th or 19th is missed. I am less sure how to handle the missed 30 day visits. If for example a 30 day period expired one week after ROC and no reassessment took place - does this mean that ll visits in the previous 30 days (ie since last reassessment) are discounted?

    By Sue Rushfirth on Dec 01, 2011 at 12:37 pm

  48. Sue,  I hope I’m following your question.  If not, e-mail me directly to discuss.  The 13th and 19th visits have definite deadlines but the 30 da assessment just has to be done “at least” every 30 days.  So if you had it scheduled and missed it for any reason you can do it at the next visit as long as it is still within the 30 days from that discilplines original assessment.

    By Jennifer Warfield on Dec 02, 2011 at 01:46 pm

  49. Where can we go to download information on the 2012 PPS Ruling changes as it applies to therapy and the 13/19 Visit Rule?

    By Diana on Dec 22, 2011 at 10:06 am

  50. Diana, click on the link for the Therapy Fact Sheet released by CMS.

    https://www.cms.gov/HomeHealthPPS/Downloads/Therapy_Requirements_Fact_Sheet.pdf

    By Jennifer Warfield on Dec 22, 2011 at 10:19 am

  51. WHEN A PT IS BEING SEEN BY ONLY 1 DISCIPLINE AND ON INITIAL EVAL RECOMMENDS 11 VISITS AND ARE COMPLETED, BUT ON THE 11TH VISIT RECOMMENDS ADDITIONAL VISITS THAT ADD UP TO 13 VISIT WITHIN THAT CERT PERIOD AND CONTINUES INTO THE NEXT CERT PERIOD. MY QUESTION IS IF THE 13TH VISIT IS A MISSED VISIT AND UNABLE TO COMPLETE BEFORE CERT ENDS WHAT HAPPENS FOR THAT EPISODE?

    By ANNA R. on Jan 06, 2012 at 04:21 pm

  52. Hello Jennifer. My query is based on coverage after 13 & 19th visit if only one discipline does not meet reassessment requirements. Specfically, if one therapy discipline is compliant with necessary reassessments at specific guidelines, but the other discipline fails to provide reassement at specific time lines required, will both disciplines not be paid until both reassessments are in? Or, will only the discpline that does not meet the requirements for reassessment not be paid?

    Thank you,
    Jen

    By jen on Jan 19, 2012 at 08:51 am

  53. Jen, if one discipline in a multi-discipline, fails to meet the requirements, it affects the entire episode until the required assessment is done.

    By Jennifer on Jan 19, 2012 at 09:05 am

  54. I RECENTLY ASKED A QUESTION #51 JUST WONDERING IF YOU HAD AN ANSWER FOR ME?

    By ANNAR on Jan 19, 2012 at 10:36 am

  55. Anna, if indeed the 13th projected visit in an episode is not done before the end of the cert period. No reassessment is required.  The therapy count starts over again in the new cert period whereby,if more than 13 are sceduled, the reassessment is required.

    By Jennifer on Jan 19, 2012 at 10:57 am

  56. If therapy evaluation was done on 1/1, is the 30 day assessment due on 1/31 or 1/30?  I was given different answers by 2 home health agencies.  Please clarify.  Thank you.

    By Lynn on Jan 22, 2012 at 08:30 pm

  57. I had a question. If i was only one discipline with a patient with my COTA doing the visits- and my 30 day re-ass falls before my 13th and 19th day, would the clock reset for my 13/19 day count or only for the 30 day count?The foll- were my actual visit dates with a patient:

    11/2- Eval
    11/7,11/9
    11/16, 11/18
    11/22, 11/23(regular sup visit)
    11/28, 11/30, 12/2(30 day)
    12/5, 12/7, 12/8
    12/13, 12/15, 12/16(regular sup visit)
    12/19, 12/21, 12/22
    12/28, 12/29, 12/30(dc)

    By Preeti on Jan 23, 2012 at 01:02 pm

  58. Preeti, as the OT, if you were the only discipline, your reassessment must occur on the 13th and the 19th visits respectively unless a situation totally out of your control prevented you from doing those visits.  The reason has to be specific and must be documented.  It appears in your situation that the COTA did both the 13th and the 19th visits.

    By Jennifer on Jan 24, 2012 at 08:13 am

  59. Lynn, If the initial visit was done on the 1st, the 30 thirty day reassessment must be done by the 30th.

    By Jennifer on Jan 24, 2012 at 08:43 am

  60. Ot eval on 08/03 and pt eval on 8/8, then 8/23 ot performs 13th visit, then ot does 30 day assessement on 09/2 and pt discharges on 9/2.
    Regarding OT Does the 9/2 30 day assessment also count for the 19th visit?  Also do you count from 8/23’s 13th re-eval 30 days to get the the next 30 day assessment?

    By Michelle on Jan 25, 2012 at 01:45 pm

  61. Michelle, I may need more clarification from you since I have no way of knowing how many visits occurred by each discipline between the initial dates you mentioned. But, I’ll take a shot at it. First, when the OT did the 13th visit, the 30 day clock started over on that visit therefore, it was not necessary to do a another visit on the 2nd unless that was also the 19th visit. The 30 day clock resets with any reassessment (ROC, Recert, 13th or 19th visits).

    By Jennifer on Jan 25, 2012 at 02:19 pm

  62. Can a therapist do a Re-Eval 7 days prior to new cert dates and it count as 1st first visit for the new cert? Or does that Re-Eval have to happen in the 5 day window? When do you start counting the visits, would it be from the Re-Eval in old cert or 1st therapy visit in new cert? Considering that every episode stands alone on the 13 and 19 assessments wouldnt that Re-Eval need to be done in the new certification?

    By Julie on Jan 31, 2012 at 11:55 am

  63. If the therapist is reassessing the patient due to a recertification, it can only be done in the 5 day window. The count starts with the 1st visit in the new episode.

    By Jennifer on Jan 31, 2012 at 12:07 pm

  64. We have PT and OT going to see a patient. OT did Re-Eval 7 days prior to new certification. PT did Re-Eval on day 5. OT then went out and did just a regular visit on day 1 of new cert. Would this visit count towards 13th and 19th visits. Or would it not due to no eval done for OT in 5 day window. Therefore, until both therapies did Re-Assessment no visits would be no visits would be billable or be countable?

    By Julie on Jan 31, 2012 at 03:02 pm

  65. If a patient is not been by the 30th day for supervisory reassessment visit how long after can the therapist see pt for the 30 day visit and Can the assisstant see the patient on or after the 30 day?

    By Anna R. on Feb 06, 2012 at 11:43 am

  66. Anna, there is no grace period here.  If the therapist has not seen the patient at least once in the 30 day period, any subsequent visits will not be paid until the reassessment is done.  If there was a visit for the 13th and/or 19th reassessment done, the 30 day clock started over with that date.

    By Jennifer on Feb 06, 2012 at 12:17 pm

  67. Patient had PT & OT scheduled for the 12/13 visits. Then ST was ordered and did eval on visit 12, moving PT & OT to 13/14.  What happens with the visits now?  Are we supposed to not count a visit done between visit 1 and visit 12?  Are we counting the 14th OT re-assessment as the 13th visit and continue the count to 19, or do we count it as visit 14?  This one baffled me.  Hope you can help - and soon.

    By Diana on Feb 26, 2012 at 10:00 pm

  68. Question: After a resumption of care and a new PT evaluation is done, does that reset the count for the 13th and 19th visit re-assessments? Or does the counting continue from the SOC?

    By Colette Kolesar on Mar 20, 2012 at 12:45 pm

  69. After an ROC that is not in the last 5 days of the cert period, the count for the 13th and 19th visits continues but the count for the 30th reassessment starts over.

    By Jennifer on Mar 20, 2012 at 01:18 pm

  70. Came across this situation. PT is the only discipline treating. Patient went in to the hospital after 11 visits had been completed. Patient came out of hospital and is due a post-hospital re-evaluation (which is visit #12). In this case, does Medicare really expect us to go out and do another re-evaluation and have back to back re-evals to satisfy the 13th visit rule and continue therapy? Back-to-Back re-evals seem kind of silly (patient status and goals aren’t going to change).

    By Scott on Mar 28, 2012 at 11:05 am

  71. Is the 13/19 visit rule applicable to MCR replacement insurances?  I have an agency that says it is.  I understood that it was only for traditional MCR.  Please let me know.  Thank you!

    By Diana on Mar 28, 2012 at 12:15 pm

  72. Diana,
    The original F2F regulation was intended solely for Traditional MCR patients.  Gradually HMS’s and other payors as well as some state Medicaids have adopted the policy.  I would suggest contacting that payor for clarification.

    By Jennifer on Mar 29, 2012 at 02:32 pm

  73. If PT is seeing pt for 10 visits, then, OT is t asked to be on case, but does not evaluate until visit number 11 combined, would the OT eval count as OT reassessment? Thank you, Jen

    By jen on Apr 10, 2012 at 08:07 am

  74. Jen, this one is a bit tricky and I hope I read the scenario correctly.  If PT had 10 visits planned but OT stepped in later and PT discharges prior to the group reaching 13 visits, PT’s obligation is met but OT’s count continues and if he plans to do more than 13 visits, the reassessment prior to #14 is still required. If PT is still in then you fall into the acceptable 11-13 visit range for multiple therapies and although PT’s visit on the 13th does not count, OT’s visit 11th will.  Note excerpt from “therapy requirement fact sheet”

    “When the patient resides in a rural area or when documented circumstances outside the control of the therapist prevent the qualified therapist’s visit at exactly the 13th visit, the qualified therapist’s visit can occur after the 10th therapy visit but no later than the 13th visit.”

    By Jennifer on Apr 10, 2012 at 09:19 am

  75. Scenario:  PT and OT are the only therapy discipline in . . PT goes out on 17th visit and ends up discharging.  Questions: Is OT required to complete their reassessment on the 19th visit now that they are considered the only discipline left or can they still complete it on the 18th visit?  Also, can a COTA or PTA perform any visits prior to all assessments being completed?

    By LYNN on Apr 10, 2012 at 04:32 pm

  76. Lynn, if the next OT visit will put the patient into the 19 or more visits, then yes a reassessment is still required.  Normally when only one discipline is in, that person should do it on the 19th visit but in this case, a visit was already part of the POC and would have been considered the 18th visit so it would qualify.
    I think I understand the 2nd question.  The COTA or the PTA can perform any scheduled visits other than those where a reassessment is required.

    By Jennifer on Apr 11, 2012 at 10:23 am

  77. Jennifer,
    I think i’m asking the question wrong . . maybe i’ll try it this way - If PT and OT are the only therapy disc in and PT goes out to complete a reassessment visit but ends up discharging which now leaves OT as the only therapy disc in - Can OT still perform their reassessment visit on #12 visit or do they have to wait until #13 because PT discharged?

    By Lynn on Apr 11, 2012 at 10:56 am

  78. Lynn, I think we’re on the same page…........what I meant was that the visit by OT (# 12) more than likely was already planned before PT dropped out so there was no need to change the plans because of PT’s discharge. So, in this case it would qualify.  Remember, in one discipline episode the reassessment must be done on the 13th visit unless pt resides in a rural area or in extenuating circumstances. I would say that since OT did not know PT was going to discharge prior to scheduling visit 12 (which would ordinarily qualify in a multi=discipline episode), it would qualify here also.

    By Jennifer on Apr 11, 2012 at 01:05 pm

  79. thank you Jennifer

    By LYNN on Apr 11, 2012 at 01:08 pm

  80. So can we assume there is some leeway to the 13th and 19th visits? You said the 11-13/17-19 visit grace period is mainly for multiple therapy situations but the Medicare q&a states that the exception only applies to patients in rural areas and that “No range has been specified for patients receiving multiple therapy types.” Is it basically ‘understood’ that reassessments for 13th/19th be done close to but not after.

    By Nu on Apr 12, 2012 at 11:59 am

  81. Jennifer, thank you kindly for your comment #74.  Yes, PT still continued past visit #13 and completed PT reassessment, but would OT eval at visit #11 count as OT reassessment for that reassessement period? (For clarification, OT came in at visit #11, as PT was only seeing pt initially).

    Thanks,

    Jen

    By jen on Apr 13, 2012 at 05:51 am

  82. Nu, the Therapy Requirements Fact Sheet says that, “for episodes with multiple disciplines the assessment must be done close to but no later than visit 13 or 19”.

    By Jennifer on Apr 13, 2012 at 09:05 am

  83. Jen, again I hope I’m following the scenario correctly.  The assessment done by OT on visit would be considered a qualified visit.

    By Jennifer on Apr 13, 2012 at 09:16 am

  84. Scenario: Patient roc from the hospital on the 11th Visit, If an evaluation was ordered and the 13th visit is only two visits away.  Is there a reassement due on the 13th visit or is the evaluation in lieu of the 13th visit.  Also, does revaluating a patient reset the counting all over again?  Thanks

    By Allison on Apr 18, 2012 at 12:04 pm

  85. Jennifer, Thank you for comment #84.  My query is, does an OT evaluation count as a reassessment if done on visit #11 in a multiple discipline case?  Just making sure that I would not also need to do a reassessment on visit #13, if an OT eval was done on visit #11 in multidiscipline case.  Thanks, Jen

    By Jen on May 04, 2012 at 05:51 am

  86. Pt has 2 disciplines in the same cert period, but one at a time. First P.T., then O.T. P.T. has finished their treatments and O.T. Evaled on the 11th visit, so does O.T. need to do the 13th reassessment since the freq will go pass 13 visits or will the 11th visit(o.t. eval) count for the 11-13th visit? Thank you for your assistance

    By anna r on May 04, 2012 at 08:09 am

  87. Anna. Since OT came in at the end but his visits will contribute to the more than 13 visits he is required to do an assessment.  In this case though it became a mutidiscipline case and his assessment on the 11th visit will qualify.  PT needs to do a reassessment before the 14th visit also.

    By Jennifer Warfield on May 16, 2012 at 10:22 am

  88. Jennifer,
      IN RELATED TO #86 P.T. HAS DC’D Pt FROM THERAPY AND O.T. DID THE INITIAL EVAL ON #11 AND YES, THIS DID MAKE IT A MULTIDISCIPLINE AND MY QUESTION IS SINCE IT IS A MULITIDISCIPLINE BUT ONLY O.T. IS OUT THERE SO, O.T. WILL NEED TO COMPLETE THE 13TH VISIT FOR REASSESSEMENT EVEN THOUGH HE JUST COMPLETED THE EVAL ON #11?

    By anna r on May 16, 2012 at 12:21 pm

  89. Hi Anna, I’ll try again.  If PT is done and the OT assessment on the 11th visit is the last in that cert period or there will be no more than 13 visit in the remaining cert period, there is no need to do a reassessment on the 13th visit.  It will only be required if the addition of OT after PT discharges will put you at over 13.

    By Jennifer Warfield on May 18, 2012 at 08:58 am

  90. If we opened a patient with multiple disciplines (including nursing), all therapy disciplines finish their POC, and nursing stays in.  Nursing decides that based upon the patient’s condition, they ask PT & OT back in.  Since the new eval is within the same episode number, does the 13 & 19 visit reassessment count continue, or because all therapy discontinued, it starts at 1 for the new evals?

    By Jessica Hackwell on May 21, 2012 at 06:10 pm

  91. The 13th and 19th visit requirement is per episode.  So if they are brought back in and now the total is more than 13 or more than 19, the requirement for the reassessment still stands.

    By JenniferWarfield on May 23, 2012 at 07:46 am

  92. If PT is seeing a patient for a 60 day cert period and a licensed therapist (not an aid) is the only person doing the visits, are the 30 day and 13th visits still required?

    By Echo B. on May 29, 2012 at 10:49 am

  93. Yes, the licensed therapist must see the patient at least once EVERY 30 days and if in that 60 day period, he has more than 13 visits, that visit must be done also.

    By Jennifer on May 29, 2012 at 10:57 am

  94. Scenario:There are 3 therapies in the home; PT, OT and ST. PT does an assessment on the 16th visit, OT does an assessment on the 17th visit, a PTA does a regular visit on the 18th visit, and ST does a reassessment on the 19th visit. Will the PTA visit for the 18th visit be paid? Or do all of the assessments have to be back-to-back?

    By Echo B. on May 29, 2012 at 11:02 am

  95. My question is similar to #70 and #84.  On a single discipline that has a re-eval schd for the 11th visit due to end of original freq,  instead of d/c, therapist orders more visits. Does he have to do a functional reassessment on the 13th visit or will the 11th visit satisfy the 13th visit rule?

    By Diana on May 30, 2012 at 08:42 am

  96. Thanks for all your help Jennifer,

    After PT frequency was set, the patient went out of town for 2 weeks and one of those weeks included the 30 day threshold. Patient returned the week after the 30 day reeval needed to be performed. When would the reeval be performed in this case?

    Thanks again!

    By Nunu on May 31, 2012 at 12:19 pm

  97. Hello Jennifer,
      I am trying to get clarification regarding discharge visits. For example, if PT/OT are both in on a case and say PT meets the 13th assessment but OT does not, then discharges on visit 14 or 15, are any subsequent visits billable? Techinically, as far as I see it, there was no reassesment dony by both disciplines. I guess then the other question is Does a d/c visit count as a reassessment??  Thank you for any clarification you can offer.

    By Nina on Jun 07, 2012 at 07:23 pm

  98. Waiting on replies:
    #67: adding another discipline when the re-evals are being done (see note)

    #95: does re-eval have to fall on 13th if last visit for original frequency falls on 11th or 12th visit for a single discipline.

    also, is there a listing for rural areas as requested by #33?

    Thank you

    By diana on Jun 14, 2012 at 01:21 pm

  99. In response to #67.

    Diana, I’m not sure what you mean by not counting visits between 1 and 12 but I will respond to the main point of the question. If the total of the PT/OT visits was more than 13 in that episode, both would have to do their own reassessment. Since they already had visits scheduled for 12 and 13, the addition of ST would obviously put them over 13. I have seen nothing in writing to address this exact scenario but in a similar post by CMS, It is expected that an agency would have anticipated the addition of a new discipline and would have planned accordingly. Therefore, PT and OT would still be expected to have their reassessments completed prior to visit 14.

    By Jennifer Warfield on Jun 17, 2012 at 05:50 pm

  100. Waiting on a response for #94

    By Echo B. on Jun 27, 2012 at 09:22 am

  101. In response to #94: As long as all 3 disciplines did their respective reassessments as close to the 19th but before the 20th visit, all visits count and are billable.

    By Jennifer Warfield on Jul 10, 2012 at 02:42 pm

  102. In response to #97: If there were more than 13 visits scheduled in the same episode and only one discipline did his/her reassessment, no further visits will be done until the visit after the reassessment is done.  So, even if OT went out on the 14th visit, payment would not resume until visit 15.

    By Jennifer Warfield on Jul 10, 2012 at 02:49 pm

  103. any ideas on the best way to keep up with when the reassessments are due, especially when multiple therapy disciplines are in the home?

    By BR in Alabama on Jul 14, 2012 at 04:14 pm

  104. IS THE REQUIREMENTS FOR THE 11-13TH & 17-19TH VISITS ONLY FOR MEDICARE PATIENTS? ARE PRIVATE PAY INSURANCE PATIENTS REQUIRED TO MEET THESE REQUIREMENTS TO?

    By ANNA R. on Aug 13, 2012 at 01:03 pm

  105. IS THE REQUIREMENTS FOR 11-13TH & 17-19TH VISITS ONLY REQUIRED FOR MEDICARE PATIENTS, OR DO PRIVATE PAY INSURANCE NEED TO FOLLOW THESE REQUIREMENTS TO?

    By ANNA R on Aug 13, 2012 at 01:06 pm

  106. If a 30 day re-assessment falls on the 11th visit, is a 13th visit re-assessment still required?

    By Echo B. on Aug 14, 2012 at 03:40 pm

  107. Response to #94.When 3 disciplines are in, all reassessments must be done before the 20th visit.
    As long as all licensed therapist did their respective reassessments before the 20th visit, they are all covered even if there was an extra non-licensed visit in the midst of the visit.

    By Jennifer on Aug 17, 2012 at 10:46 am

  108. In response to #103

    The best way that I have found if you do not have a therapy coordinator is to make a calendar for each patient at the beginning of each episode that maps out each visit and when each reassessment is done.  One copy should be left with the chart and one copy distributed to each therapist involved.

    By Jennifer on Aug 23, 2012 at 07:14 am

  109. Response to #104

    The requirement for the reassessments is only for traditional Medicare patients but many clients have reported that Medicare Advantage, Private Payors and in some states Medicaid are asking for them.  My suggestion would be to take a few minutes and call the ones you use most just to clarify.

    By Jennifer on Aug 23, 2012 at 07:35 am

  110. In response to # 106

    Yes, if the 30th day reassessment is done in a one discipline episode, another reassessment is required on the 13th visit. The response below is directly from the latest CMS Q & A’s regarding Therapy Reassessments.

    “Question 9: If a therapist’s reassessment that satisfies the “at least every 30 days” therapy reassessment requirement occurs before the required 13th therapy reassessment visit, is the qualified therapist still required to perform the 13th therapy reassessment visit?

    Answer 9: Yes, the therapist would need to perform the therapy service/reassessment/measurement/documentation at the 13th visit.”

    By Jennifer on Aug 23, 2012 at 07:46 am

  111. Hello,

          I have the following question:
    The 30 Day clock starts the same day as the last Eval or the day after the Eval?

    By Mary on Sep 07, 2012 at 02:32 pm

  112. Mary, the count to the next 30 days should start on the day after the reassessment is done.

    By Jennifer on Sep 07, 2012 at 02:48 pm

  113. If the therapists do not complete their 13 visit and 19 visit reassessments on time, and the RN visits before the required assessments are complete, are the RN visits paid by Medicare?  Does everything become nonbillable until the reassessments are complete?

    Thanks!

    By Tammy Farrell on Sep 13, 2012 at 11:07 am

  114. Tammy,
    If the 13th or 19th visit reassessment is missed, only the therapy reimbursement is affected.

    By Jennifer Warfield on Sep 13, 2012 at 02:06 pm

  115. How is Recerts handled with the new 13th, 19th, 30 days reassessments for Therapy?  Does the 1st visit in the new Cert period count as visit #1 and do we mark the visit in the old cert a reassessment for the recert?  This would be if Nursing is doing the Recert OASIS but therapy is still involved.  Thanks

    By Melissa McDowell on Sep 24, 2012 at 08:08 am

  116. In your comment, #53….I keep seeing “until the reassessment is done.” Does that mean you can bill previous visits once the reassessment is done (late)?

    By Tabetha Logan on Oct 18, 2012 at 01:50 pm

  117. As the guideline reads today, if the required reassessment is not done before the 13th or the 19th visits,the agency will not be paid.  The assessment should be done as soon possible but will not be able to resume billing until the next visit. Any visits done between the 13th or 19th visits and the visit where the reassessment is completed, will not be billable. There is a proposal on the table for the 2013 Final Rule to change the guideline allowing the actual reassessment date to be a billable visit.

    By Jennifer on Oct 18, 2012 at 02:33 pm

  118. When you say “the agency will not be paid” does this mean for all visits, therapy, HHA, RN?  Or just therapy?

    By Tammy Farrell on Oct 18, 2012 at 09:12 pm

  119. Jennifer,
    Please help me understand something better.  I am seeing a patient for PT and my coworker is seeing them for OT.  On visit number 17 I discharge them from PT and on visit number 19 they are discharegd from OT as well as Oasis d/c to discharge from agency.  I am being told by the owner that I need to add a functional reassessment for the 17th visit and that OT must add a functional reassessment for their 19th visit and that without it the system is giving them an error and not letting them submit it for billing.  Is this necessary since we obviously didn’t reach the 20 visit level.  And if it is not necessary is there somewhere where Medicare states this in writing so I can show this to the owner?  Thanks.

    By Leigh on Jan 26, 2013 at 04:34 pm

  120. Leigh, if reassessments were done by both disciplines (PT and OT) prior to visit #14 and the patient was discharged before the next threshold of 20 visits, the only assessment that is necessary is the discharge assessment.

    By Jennifer Warfield on Jan 28, 2013 at 03:01 pm

  121. OK, confused, thought I had it but now not so sure. We understand the 13th, 19th visit fine and that the 30 eval has to be done but starts over with the 13th or 19th etc. confusion is if therapy continues over into a 2nd episode. If the eval say for the 13th visit was done 2 weeks prior to new episode and was ordered to continue for 4 weeks, which would carry it into the new cert; does yet another re-eval have to be done within the 5 day window or 1st visit of new episode? don’t understand why it would, but have been told both ways and I have never worked at an agency that did it this way. any help is greatly appreciated. thanks!

    By Jeantta on Feb 27, 2013 at 01:42 pm

  122. Once the new episode begins, the 13th and 19th visit for reassessment starts over but the 30 day requirement began whenever the last assessment was done.  There is no requirement for an assessment in the 5 day window unless this is a therapy only case and therapy would be responsible for the re certification,

    By Jennifer Warfield on Feb 27, 2013 at 02:41 pm

  123. 13th, 19th and 30th day reassessments were done in the first cert period by the OT and PT, they continue with several return visits after that and both decide to continue with therapies and do a recertification. Both disciplines do their recert 4 days prior to end of first cert period. Then the first PT return visit was done 2 days later and the first OT return visit was done one week later. Do they count the recert which was done in the old period as first visit or do they start the count once the new episode starts with the new recert dates. If so how do we count that first return PT visit that was done while still in the old cert period.
    Do we even need to start the count again in a new cert period or does the 13th and 19th day assessment refer to just that.
    If a patient goes through 3 cert periods would that mean there should be 3 sets of 13th day, 19th day and 30th day reassessments?

    By Fiona Bloom on Mar 08, 2013 at 01:56 am

  124. Are you using recert and episode interchangeably?
    My question is this:

    does the 13th/19th count begin anew each RECERT?

    By kate on Mar 22, 2013 at 11:42 am

  125. In response to #124…....the 13th/19th reassessment requirement is for EACH episode of care.

    By Jennifer on Mar 25, 2013 at 08:43 am

  126. please answer this question what on this soc is billable and explain why or why not:  soc starts 3/30/13 pt 2wk9, ot 2 wk 9 ...4/1/13 lpta, 4//2 cota, 4/3 lpta, 4/4 P.T. reeval also O.T. reeval then 4/8 cota and lpta, 4/10 lpta, 4/11 cota, 4/12 lpta, 4/15 lpta, 4/16 cota, 4/17 lpta, 4/19 lpta and cota, 4/23 cota and P.T. reeval, 4/24 lpta, 4/25 cota, 4/26 lpta, 4/29 lpta, 5/1 lpta, 5/2 O.T. reeval, 5/3 lpta, 5/7 cota and lpta 5/8 cota and lpta, 5/10 lpta, 5/13 lpta, 5/14 cota, 5/15 lpta, 5/16 cota, 5/17 lpta, 5/20 lpta, 5/21 P.T. reeval, 5/23 cota, 5/24 cota…....thanks

    By darlene on May 30, 2013 at 03:34 pm

  127. Can a Therapy discipline (P.T., O.T. & S.T.) have a freq of 1x a wk OR Do they need to see a patient 2x a wk?

    By anna r on Jul 09, 2013 at 01:35 pm

  128. There are no restrictions on how many times a week you must see a patient.

    By Jennifer Warfield on Jul 09, 2013 at 02:38 pm

  129. WHEN A PATIENT HAS THERAPY AND THE TREATING THERAPIST IS THE P.T. OR O.T. NOT THE ASSISTANT COTA/PTA, DOES A 30 DAY R/E NEED TO BE COMPLETED? ALSO DOES THE S.T. FALL UNDER THE SAME FOR 30DAY R/E?

    By ANNA R. on Jul 12, 2013 at 09:51 am

  130. Anna, the 30 day reassessment is required regardless of you did the visit.  The only time you wouldn’t need to do a separate visit would be when a recert, 13th or 19th visit reassessment has already been done.  The 30-day requirement starts over whenever any other reassessment has been done.

    By Jennifer Warfield on Jul 12, 2013 at 10:31 am

  131. IF the RN completes the SOC, how long do the therapists have to get out to begin their evaluations? I had always thought it was 48 hours, but now I am being told it is 5 days. 
    Thanks!

    By Tammy F on Jul 12, 2013 at 11:16 pm

  132. On the 30day, 13th Re-Evals does the MD need to sign it if no changes are indicated and it will say to complete current POC? Also Can it be stamped F.Y.I (no signature need and faxed to MD)?

    By anna r on Jul 15, 2013 at 10:11 am

  133. Anna, there is no requirement for the physician to sign the re-eval but if it results in a change to the POC, the POC would need to be signed.

    By Jennifer Warfield on Jul 15, 2013 at 11:02 am

  134. Q132…Tammy, If the RN is opening the case for a “therapy only” episode and she will not be providing a skill, she has to do the OASIS on the same day of the therapist’s visit or within 5 days as the therapist first skill visit establishes the SOC date.  The OASIS cannot be done before the SOC date.  If SN will also be on the POC, there is no requirement for the therapist to see the patient in a certain time as long as it conforms to the physician’s orders and doesn’t delay care.

    By Jennifer Warfield on Jul 15, 2013 at 11:06 am

  135. In regards to the “5 day rule” to re-evaluate patient for new certification period for therapy, is there any official rule or guideline I can supply to our contracting agencies? If so, where may I find it?

    Thank you

    By Kristina on Jul 16, 2013 at 11:13 am

  136. WHEN A THERAPIST ARRIVES AT A PATIENTS HOME AND PT IS C/O A HEADACHE, SO THERAPIST CONTACTS MD OFFICE, BUT TAKES ABOUT 20 MIN. ON THE PHONE. WILL THAT TIME BE CONSIDERED PART OF THE 45 MIN TREAMENT OR WHEN WILL IT START?.......THANKS FOR ALL YOUR INPUT/HELP ON OUR ISSUES TO HELP BETTER UNDERSTAND THIS CORRECTLY.

    By ANNA R. on Aug 26, 2013 at 03:41 pm

  137. I WAS TOLD THERAPY HAVE TO GET RE-EVAL DONE BEFORE THE CERT. MY THERAPY TELLS ME THAT IS NOT THE CASE.
    IS THAT TRUE!

    By NEETA SAMANI on Sep 17, 2013 at 12:05 pm

  138. Neeta, If this is a therapy only case then yes, a recert is necessary.  Otherwise the re-evals for the 13th and 19th visits are still required.

    By Jennifer Warfield on Sep 17, 2013 at 02:37 pm

  139. When a P.T is following the patient for the entire episode, how does the re-assessment stand out from the other visits if it produces the same G code as an Eval or P.T visit? Should the reassessments have a separate G code?

    By Amanda on Oct 01, 2013 at 10:15 am

  140. There is no G-code specifically for a reassessment.  It should be done during a routinely scheduled visit and in that case, use the G-code for that visit.

    By Jennifer Warfield on Oct 03, 2013 at 02:11 pm

  141. I was told that Medicare considers all Home Health therapy discharge assessments to be “evaluations”.  Is that the case?

    By Debbie V on Oct 21, 2013 at 11:23 am

  142. SINCE A THERAPISTS R/E NEEDS TO BE APPROVED/SIGNED BY MD TO CONT. ADDT’L FREQ BUT IS UNABLE TO GET A VERBAL FROM MD OFFICE TO CONTINUE THAT FREQ. WE DO NOT GET MD APPROVAL/SIGNATURE UNTIL 10.31.13.  . HOW WOULD THE FREQ RESUME? EX: CRT IS FROM 09.24.13 - 11.22.13 S.T. R/E ON 10.18.13 FOR A 2W4, 1W1 EFF 10.22.13. WILL FREQ BE COMPLETED AS A 2W2, 1W1(CAUSE THAT IS WHERE FREQ SHOULD BE AT FROM 10.22.13) OR CAN IT BE A 2W3 EFF 11.04.13, THEN EFF RC 2W1, 1W1 (TO COMPLETE AS PER R/E 10.18.13)......BUT IF NO EFF DATE IS MENTIONED CAN IT RESUME WHEN WE GET MD SIGNATURE EVEN THOUGH IT GOES INTO RECERT OR NOT…..THANKS ANNA R

    By ANNA R on Oct 31, 2013 at 02:14 pm

  143. DUE TO CIRCUMSTANCES A PATIENT WAS UNABLE TO DO THERAPY TREATMENT BUT, THERAPIST DID VERBAL TEACING TO PT/CG OF SEVERAL ASPECTS OF SAFETY. CAN THIS BE A BILLABLE VISIT?

    By ANNA R on Nov 01, 2013 at 09:41 am

  144. Jennifer,
    I have a patinet that was being seen by ST and PT. ST frequency was 1w5 and DC’ed early after the third visit. PT frequency was 3w1;2w3. The patient was admited to the hospital 3wks into the episode for 10days. PT evaled for the resumption 3w1;2w4… The week therapy should have scheduled the 13th assessment the patient requested to be discharged. The actual 13th visit was made by a PTA and the following visit was a missed PT visit. Q. Since the 13th visit was done but by a PTA and no therapy DC assessment was done would this be a non-billabe visit?
    I am being told that since there was no visit made beyond the 13th visit an assessment is not required. The discharge was an agency DC. See visits below:

    8/28 ST Eval
    8/29 PT Eval
    8/30 PTA
    9/3 ST
    9/3 PTA
    9/4 PTA
    9/6 PTA
    9/10 ST DC
    9/10 PTA
    9/25 PT Eval (for Resumption)
    9/26 PTA
    9/27 PTA
    10/1 PTA
    10/2 Missed visit PT
    10/4 Agency DC

    By Melinda Cribb on Nov 22, 2013 at 08:29 am

  145. Could you clarify how this applies to “Therapy Only” admissions - that is a patient who had homecare orders for only PT, so the PT goes out, does their eval & admission paperwork but finds a RN need, so calls the MD for an RN order, and the RN goes the next day & does the OASIS, and the PT the goes on the next visit as a regular treatment.  But, the first eval admission visit was actually not covered, so does that mean it does not count and the PT would need to document a reassessment on the second visit and start the count there as 1?  How do others handle this?

    By Jen on Jan 09, 2014 at 07:56 pm

  146. In the scenario, you described, The PT’s first visit can be a billable visit as it was the first skilled visit.  The need for SN was not added until after the fact. If the need for SN had been evident before the first PT visit, SN must do the initial assessment.

    By Jennifer Warfield on Jan 13, 2014 at 11:49 am

  147. Hi Jennifer,
    When there are multiple therapies in and each has completed their 11-13th re-assessment as required, what happens if one or more therapist complete a discipline DC during the 17th-19th visit? Is that a billable visit? Is a functional reassessment needed AND a discipline discharge? Or..can the discipline discharge be billed as a funtional re-assessment?

    By Michelle H on Jan 23, 2014 at 03:09 pm

  148. Does the physician have to sign each re-eval? What if the therapist did a re-eval on the 10th visit, then discharged with an OASIS on the 11th?

    By Deborah H on Apr 17, 2014 at 05:38 pm

  149. If a therapist does an eval only…is there any reason a dc summary has to be done if the patient refuses therapy services?

    By jackie on Apr 24, 2014 at 01:37 pm

Leave a Comment

Name
Email (will not be displayed on your comment)
URL
Comment

Remember my personal information

Notify me of follow-up comments?

Please answer the following question to prove that you are human:

What color is the sky?