Medicare Basics for StudentsPresented by Joselyn Eitemiller

October 21, 2010

Medicare Program

Medicare Part A- Entitlement Program 65 years old; pay into the system or have spouse who did 3 day qualifying stay in hospital; up to 100 days for recovery if therapy or nursing can

“skill” Eligible for another 100 days after 60 day break in spell of illness Covers room, board, and most services at 100% for the first 20 days Covers room, board, and most services at 80% after day 21

Medicare Part B – Elective Program Covers ancillary services (therapy included), durable medical equipment, etc. Does not

cover room and board Covers therapy services at 80%

Medicare Part C – Medicare Advantage Program Participants waive other Medicare benefits for management under an HMO

Medicare Part D – Prescription Drug Program

Medicare Part A

Skilled Nursing Facilities (SNFs) are reimbursed based on the rules of the Prospective Payment System (PPS). The Minimum Data Sets (MDS) is the tool used to assessment patients and their reimbursement level

Reimbursed based on the extent of services provided to the patient or the “burden of care”. Greater “burden of care” = higher reimbursement

The patient is assessed a minimum of 5 times in 100 days to determine “burden of care”. Each assessment looks at services over a 7 day period.

Resource Utilization Groups (RUGS) are assigned based on “burden of care” for each assessment. 66 different RUGs exist, paying different reimbursement levels.

Most of the highest reimbursing RUGs involve therapy (OT, PT, and/or Speech Therapy) providing service 5 times per week

There are 23 “Therapy RUGs” that reimburse at different levels based on the number of minutes therapy provides in a 7 day period combined with the other services provided. More minutes provided = higher reimbursement

Therapy RUGs

Rehab Ultra High 720 or more total minutes of therapy in a 7 day period Minimum of 1 discipline, 5 times per week, and 1 discipline, 3 times per week

Rehab Very High 500 – 719 minutes of therapy in a 7 day period Minimum of 1 discipline, 5 times per week

Rehab High 325 – 499 minutes of therapy in a 7 day period Minimum of 1 discipline, 5 times per week

Rehab Medium 150 – 324 minutes of therapy, 5 days of therapy with any combination of disciplines

in a 7 day period Rehab Low

45 - 149 minutes of therapy, minimum of 3 days of therapy with any combination of disciplines in a 7 day period

Modes of Therapy Minutes

Individual - treatment of one resident at a time with the resident receiving the full attention of one therapist/assistant. All of these minutes can be counted toward the total for the 7 day assessment period.

Concurrent - treatment of two residents at the same time when the residents are performing two different activities regardless of payer source; both in line of site of therapist/assistant. Only ½ of these minutes can be counted toward the total for the 7 day assessment period.

Group - treatment of two-four residents regardless of payer source; are performing similar activities under supervision by one therapist/assistant who are not supervising any other individuals. All of these minutes can be counted toward the total for the 7 day assessment period – up to 25% of the total for each discipline. After 25%, they cannot be counted.

Evaluation minutes do not count toward the total for the 7 day assessment period

Medicare Part A and Students

Student treatments are allowed under PPS and can be counted toward the minutes needed during each 7 day assessment period

Therapy students must be in line-of-sight supervision of the qualified therapist/assistant when providing services

Minutes may be counted as individual therapy when only one resident is being treated by the therapy student and supervising therapist/assistant is in line-of sight

Minutes are counted as concurrent when the therapy student is treating one resident in line-of-sight and the supervising therapist/assistant is treating another resident; or the student is treating two residents in line-of-sight of the supervising therapist

Group therapy to 2, 3, 4 residents can be provided by a student as long as the supervising therapist/assistant is in line-of-sight; supervising therapist/assistant cannot be performing care with other residents

MDS 3.0

MDS 3.0 refers to the new PPS assessment tool developed by Medicare and implemented on October 1, 2010. MDS 2.0 was the previous tool.

This new assessment increased the number of RUG levels from 53 to 66 This new tool is meant to increase patient involvement in the assessment

process Allocation of minutes into the three modes (Individual, Concurrent, and

Group) is new to MDS 3.0 Only allowing ½ of the concurrent minutes is also new. All concurrent

minutes were counted on MDS 2.0 Allocating student minutes into concurrent when the supervising

therapist/assistant is also treating was also changed under MDS 3.0 Other changes:

Therapy techs cannot provide “skilled” services New types of assessment created to help capture “burden of care” between regular

assessments

Medicare Part B

Part B services are used to reimburse therapy when the patient does not meet the qualifications for Part A services

Reimbursed by individual service provided – CPT (Current Procedural Terminology) or HCPC (Healthcare Common Procedure Coding) codes. Each code gets reimbursed at a set level based geographical area and determined “skill” involved in the care.

Examples: 97001 – Physical therapy evaluation 97110 – Therapeutic exercises 92526 – Swallowing treatment

Some CPT/HCPC codes are service based – meaning reimbursement is the same regardless how many minutes are provided

Some CPT/HCPC codes are time based – meaning reimbursement is based on 15 minutes increments

Concurrent therapy is not allowed with Part B patients Group therapy is allowed with Part B patients

Medicare Part B and Students

Therapy students must be in line-of-sight supervision of the qualified therapist/assistant when providing services

Student treatments cannot be billed to Part B

The supervising therapist/assistant must bill all services provided by students

Medicare Basics for Students

Questions?

Who is RehabCare?

Student and New Grad Programs

Clinical Education Sites – (CES) provides a quality internship experience for future clinicians. Affiliated with various universities nationwide.

AIM (Advise, Inspire, Mentor) – Our mentoring program, AIM, pairs new graduates with seasoned professionals to help them learn first-hand about their profession, the work environment and the culture of the RehabCare.

OpportunityU – RehabCare understands the financial investment it takes to become a rehabilitation professional. OpportunityU helps students and new graduates save on education costs through tuition assistance and forgiveness.

The Blog Spot – Our student blog was create to give students another avenue of communication with RehabCare.

Visit our blog at http://college.rehabcare.com

– Over 27 years, providing post acute care services– In 42 states, 1,260 facilities– Skilled Nursing, Hospital Rehab Services, LTACH & Rehab Hospitals– Over 15, 000 clinicians

Contact Us

For information on Career Opportunities, the RehabCare student and new graduates programs, contact:

Fernando RodriguezManager – Campus Relations (Western US Region)

FXRodriguez@Rehabcare.comPh. 800-677-1202 ext 2139

Check out our Blog, we’d like to hear from you: http://college.rehabcare.com

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