Hi everyone!
So I have a therapist directed question that I am seeking answers
for.
My questions are regarding documentation for ALS/neuromuscular
clinics.
At our clinic in Fresno the therapists are employed by the hospital
and the doctors are a separate entity. On clinic days when all disciplines
see the patients we have our own documentation/reports that we complete in
order to chart progression, changes
and interventions. Those reports are shared with the team treating the
clinic patients.
We have run into some questions regarding Medicare guidelines and long
term patients with progressive diagnoses. For example, Medicare guidelines
require a progress note every 30 days. If weâre not able to chart
âprogressâ Medicare requires a short certification
period and then a discharge of the patient. The problem with our ALS
population is that weâre seeing them long term every 90 days. It
doesnât make sense to chart a progress note if weâre only seeing
the patient every 90 days! Also, aside from achieving short
goals we will never chart actual âprogressâ as they define
it. Additionally, Medicare wants patients to be seen short term for 90
day certification periods. Of course weâre going to be seeing our PALS
long term as long as they come to their clinic appt
quarterly. According to Medicare it is non compliant to keep a
patientâs âcaseâ open without clear progress and
improvements charted within the 90 certification period.
So that leads me to my questions for you! How exactly do the
therapists see your long term neuromuscular patients?? As therapists are
you loaned to the doctors on clinic days and just complete clinic notes for
the treating physician? Or do you have your
own separate documentation you keep?
Here we are treating as therapists employed by a separate entity.
Therefore we have to keep Evaluations, progress notes and discharges for
our own facility. The problem is that as far as documentation is concerned
there are no separate Medicare guidelines
(that Iâm aware of) for long term progressive patients (when it comes
to documentation).
We do not want to be out of Medicare compliance and are seeking any
answers from other therapists treating progressive patients in similar
settings! Any information is greatly appreciated. Please email or call me
directly with your input! Our clinic has
been a great asset to our community here and our number one goal second to
patient treatment is to stay open and compliant!
Thank you.
Erin Singleton M.A., CCC-SLP
Neuroscience Outpatient Rehabilitation Center
2335 East Kashian Lane, Suite 301
Fresno, California 93701
Office: (559) 459-6056
Fax: (559) 459-2957
Email:
xxxxxx@xxxxxxxxxxxxxxxxxxxx
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