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May is Better Hearing & Speech Awareness Month

 

May is Better Hearing & Speech Awareness Month. Speech-Language Pathologists play an important role in working with the aging population. Speech-Language Pathologists are highly trained to help older adults with communication, cognitive and swallowing impairments due to illness, trauma or disease.

Signs of Speech and Language Disorders:

    • Having Difficulty Communicating to Others
    • Struggling with Speaking Clearly
    • Having Problems with Expressing Your Thoughts
    • Hoarse or Raspy Voice
    • Trouble Swallowing
    • Frequent Coughing or Choking During Meals
    • Extra Effort or Time Needed to Chew or Swallow
    • Saying Words in the Wrong Order
    • Avoiding Social Activities

If you or a loved one is experiencing any of the above signs, talk to your doctor about Speech Therapy. Speech-Language Pathologists can help older adults communicate their needs better, boost their memory and thinking skills, and improve their ability to swallow.

Speech Therapy can help you have a better quality of life!

Source: www.asha.org

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Homemade Cloth Masks: Proper Washing Guide

Proper Washing Guide for Homemade/Donated Cloth Masks

  • Before Your First Wear, Wash or Soak in Vinegar to Preserve the Color—Since They will be Washed Often
  • Washing Machine Recommended Versus Handwashing
  • If You Wash Multiple Masks Together, Tie the Strings Beforehand to Prevent Tangling
  • Feel Free to Throw in Regular Wash or Use a Garment Bag
  • Wash on Warm to Hot with Detergent: Click here to see a list of approved detergents to fight the Novel Coronavirus.
  • Dry in a Dryer
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Occupational Therapy Helps People Enjoy Life

Occupational therapists enable people of all ages to live life to its fullest by helping them promote health, and prevent (or live better with) injury, illness, or disability. Occupational therapy interventions include helping people learn how to compensate and/or regain skills in order to lead a full and productive life.

Occupational Therapy Interventions Include:

  • Guidance on how to make daily life activities easier
  • Therapeutic exercises to improve range of motion and strength
  • Learning new ways of doing things after an illness or injury
  • Modifying your home/living environment
  • Techniques to manage pain
  • Recommendations on equipment and assistive devices
  • Strategies to manage forgetfulness and memory problems
  • Caregiver education and support

Celebrate Occupational Therapy Month

April 2020

Occupational therapists dedicate their lives to helping others achieve their best life by helping them overcome life changes after an injury or illness or due to aging. If you think you or a loved one could benefit from the help of an occupational therapist talk to your doctor today!

 

Improve Brain Health & Memory

As we age, our bodies go through a lot of changes including the brain. Aging often causes us to experience normal changes in memory such as losing our car keys, recalling someone’s name and forgetting an appointment. Although subtle memory changes are normal, if memory loss disrupts your daily life or ability to function this could be a warning sign of a more serious problem such as Alzheimer’s or other dementia.

While there is no surefire way or magic pill to prevent cognitive decline, research suggests certain activities do play a role in improving overall brain function and health.

Simple Tips to Improve Your Memory:

  • Physical Exercise:  Physical activity can lower your risk of memory loss by increasing blood flow throughout your body including your brain. Older adults should get at least 2.5 hours of moderate aerobic exercise every week.
  • Mental Exercise:  Stimulate your brain with challenging activities at least once or twice a week. Learn a new language, play a new instrument, try a new hobby or craft.
  • Diet:  Maintain a healthy diet that includes fruits, leafy green vegetables, whole grains, and Omega-3 fatty acids like fish, walnuts and soy beans.
  • Stress:  Protect yourself from stress which can negatively impair memory and cognitive function in the brain. Focus on ways to relax such as yoga, tai chi, deep breathing, and meditation.
  • Sleep:  Quality sleep is the most important thing you can do to reset your brain and allow it to heal and restore mental health. (7-8 hrs of sleep recommended for people age 65+)

If you are having problems with completing daily tasks, comprehending and/or expressing thoughts, please talk to your doctor. Ask your doctor if therapy could benefit you. Our therapy team can discuss the role of therapy in dementia and benefits of physical, occupational and speech therapy.

Prior-Authorization is Required for Humana Part B Through Optum/OrthoNet

Effective January 1, 2020 prior authorization from Optum/OrthoNet is required for all physical therapy, occupational therapy, and speech therapy providers as well as any provider type billing one of the below CPT codes for Humana Commercial, Medicare Advantage, and dual Medicare-Medicaid plan members:

420, 421, 422, 423, 424, 429, 430, 431, 432, 433, 434, 439, 440, 441, 442, 443, 444, 449, 92507, 92508, 92520, 92526, 92606, 92609, 92630, 92633, 97010, 97012, 97014, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036, 97039, 97110, 97112, 97113, 97116, 97124, 97127, 97139, 97140, 97150, 97164, 97168, 97530, 97533, 97535, 97537, 97542, 97545, 97546, 97750, 97755, 97760, 97761, 97763, 97799, G0129, G0283, S9152, V5362, V5363, V5364

Physicians who have contracts with Humana to perform office-based physical, occupational or speech therapy and outpatient physical, occupational and speech therapy performed in a hospital will require Optum/OrthoNet prior authorization.

Inpatient rehabilitation, rehabilitation services performed in the home (including but not limited to those provided by a home health agency), services provided by chiropractors, and cardiac and pulmonary rehabilitation are excluded from Optum/OrthoNet management.

HTS Partners, see your Regional Director for helpful resources.

A Note from the field:

Many of our communities did not have news or much guidance about this new requirement prior to January 1st. Our Regional Directors report that partner clients were able to successfully fax in the information (per the request of Optum) and gain authorization for claims started after January 1st. If the claim originated in December and continued past January 1, 2020, a pre-auth is not required unless you anticipated the services extending past February 1, 2020.

Anthem Following in March:

Anthem has also merged with Optum/Ortho-Net and the prior-authorizations for Anthem Part B through the Optum site will be required starting March 1, 2020.

 

Please contact your HTS Regional Director for any questions and assistance.

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SLP Case-Mix Group: What We’ve Learned

Accurate coding for the SLP Component under the PDPM reimbursement methodology has been an area of opportunity across the industry. HTS has uniquely positioned itself with a team of seasoned therapists and nurses to analyze data and trends to optimize systems and processes to assure a smooth transition into PDPM. Now that we have three months of PDPM under our belt, here is what we have learned:

  • A tool to communicate SLP evaluation findings to the IDT will streamline the process and optimize IDT collaboration. Our MDS coordinators have enough on their plates. Let’s make it as easy as possible to present them with information so they can make the best coding decisions. HTS has created a tool for this, “HTS IMA SLP Component Communication Tool.” This tool is completed by the SLP and/or OT to provide information regarding sections B, C, I, and K related to the SLP therapy PDPM component. The tool is also equipped with a coding reference to assure that therapists are familiar with the RAI language and coding instructions.
  • Best practices when administering the BIMS is an area of opportunity. HTS recommends reviewing interview guidelines from the RAI, coding tips, and BIMS basics. Use HTS’ “Cognitive Assessment Quick Reference” for a guide to optimize practices in these areas. Also, remember the BIMS is a brief test and is not sensitive enough to capture some cognitive deficits such as executive functioning impairments. Even if a patient is “cognitively intact” (BIMS score of 13, 14, or 15), they still may benefit for cognitive-communicative therapy. The SLP will have formal testing to identify these areas of deficit and create short term goals associated with these areas.
  • If a patient scores in the SA case mix group indicating there are no items coded for the SLP component, the patient can still qualify and benefit from therapy. As mentioned in #2, the formal testing selections by a SLP will be more sensitive to cognitive impairment and therefore capture deficits more brief tests will not. However, if a patient is coded as “SA” and would benefit from speech-language therapy, HTS recommends going over the patient record to assure coding accurately reflects the patient’s medical complexities. Often times aphasia in section I4300 of the MDS may be a coding opportunity but also may require querying the physician. Additionally, section K coding best practices could also result in a more accurate SLP case-mix group.
  • Section K coding and optimization requires IDT collaboration. 2017 CMS data analytics revealed that section K coding was also an area of opportunity. In the past many have relied solely on the dietary department for section K coding. We’ve learned the SLP observations are also an important factor when coding section K accurately. For this reason, HTS created a “Quick Reference Optimize Coding in Section K” and “RAI Instructions for Completion of Section K.” Additionally, a webinar is available on the partner portal, “PDPM: SLP Component and Accurate Reporting of SLP Comorbidities.”

As we continue to navigate new waters under the PDPM methodology, we have adapted and modified our systems and processes to assure patient-centered care is at the forefront and best practices are in place. Accurate SLP component coding allows us the opportunity to more accurately depict the patient’s medical status and individualized needs. HTS will continue to provide the resources and tools to achieve IDT collaboration for the best patient outcomes possible so together we can drive quality improvement.

Written By: Sheena Mattingly, M.S., CCC-SLP, RAC-CT, Director of Clinical Outcomes

Cognitive Therapy Coding Changes Effective 1/1/2020

The CY 2020 Physician Fee Schedule Final Rule updates payment policies, rates and provides other provisions for services under the Medicare Physician Fee Schedule (PFS) effective January 1, 2020. Below are changes related to cognitive therapy coding.

 

Deleted CPT Codes Effective January 1, 2020

97127 Therapeutic interventions that focus on cognitive function (e.g., attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g., managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one) patient contact (Report 97127 only once per day)

G0515 Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes

 

New CPT Codes Effective January 1, 2020

97129 Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes (Report 97129 only once per day)

97130 Each additional 15 minutes (list separately in addition to code for primary procedure)

(Use 97130 in conjunction with 97129) 97129 represents the first 15 minutes of therapy. Report 97130 in conjunction with 97129 when therapy extends beyond the first 15 minutes.

(Do not report 97129, 97130 in conjunction with 97153, 97155)

References:

CY 2020 Physician Fee Schedule Final Rule

ASHA

2020 OIG Work Plan

The Office of Inspector General (OIG) 2020 workplan includes residents who were receiving Medicaid nursing home care and then were hospitalized. The beneficiary then returned to the same facility and received Medicare covered post-hospital SNF care. In some cases, hospital physicians discharged beneficiaries to home rather than the SNF, yet nursing facility physicians certified that skilled care was needed. Because Medicare pays substantially more for SNF care than Medicaid for nursing home care, nursing home facilities have financial incentives to increase the level of skilled care. This will be the focus of OIG medical review.

 

What will the OIG use to determine if the post-hospital SNF care is dually eligible?

  • the SNF level of care was certified by a physician (e.g., a hospital or SNF physician) or a physician extender (i.e., a nurse practitioner, clinical nurse specialist, or physician assistant);
  • the condition treated at the SNF was a condition for which the beneficiary received inpatient hospital services or a condition that arose while the beneficiary was receiving care in a SNF for a condition for which the beneficiary received inpatient hospital services;
  • daily skilled care was required
  • the services delivered were reasonable and necessary for the treatment of a beneficiary’s illness or injury; and
  • improper Medicare payments were made on the claims we review. We will also determine whether any of the hospital admissions we review were potentially avoidable

 

Prepare for the 2020 OIG Work Plan:

  • Develop policies and procedures related to admission and determination of appropriate level of care and individualize them for your facility.
  • Assure your process for attaining hospital records is timely. This is crucial for not only response to OIG review requests but also for timely PDPM processes including identifying NTA components.
  • Review your facility’s communication for medical review. Did you know HTS partners with a third-party company to complete medical reviews on your behalf? Ask us about our Denials Management Processes today!

 

Bottom Line: There is a very short timeframe for response.

  • Hospital discharge records requested within 7 days and remaining documents within 15 days
  • Specific policies and procedures must be submitted for review as well as facility specific questions related to determining level of care:
    • Policies and procedures related to admission of patients into SNF care
    • Policies and procedures related to determination of appropriate level of care (unskilled/custodial care and skilled care)

Read more

Winter Threats to Your Heart

Winter and bitter cold temperatures pose danger for those with heart disease and especially for older adults. Understanding your personal heart attack risk is vitally important during winter months. It is also important to be aware of the threats cold weather can bring and take appropriate precautions to ensure your safety.

 

Safety Tips for Cold Weather:

  • Avoid alcohol as it gives you a false sense of warmth and can cause your heart to work harder.
  • Don’t overdo it, start your morning off slow. The cardiovascular system can adapt to slow, progressive change. Avoid sudden exertion like shoveling snow and take frequent breaks.
  • Prevent hypothermia by wearing a hat and layers of clothing to protect you from
    cold temperatures. Older adults have lower subcutaneous fat and are more prone to suffer from hypothermia.
  • Remain hydrated and drink water regularly to prevent overexertion and dehydration.
  • Breathe through your nose in cold weather; your nose has various defense mechanisms to prevent impurities and excessively cold air entering your body.

 

If you would like to learn more about a heart-healthy lifestyle, visit our therapy department. Physical and Occupational therapists can help you to develop a healthier lifestyle and reduce many of the risk factors that cause cardiac conditions. Cardiac rehabilitation programs are designed to help you control your symptoms and resume an active and productive life within the limits of your condition.

 

References: American Heart Association

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Assistive Devices to Help Promote Independence

As you get older, you may start to have trouble with everyday tasks such as bathing, picking up things off the floor, or even just getting around.  Assistive devices are products and tools that can make life easier. They might be new things you add to your home, or improvements to something you already have.  The first step is recognizing when and where you could use some extra help. Sometimes people adapt to changes in their ability level, giving up things they like to do without even recognizing it.

Here are some ideas that could help make your daily activities easier:

Getting Around:

  • A cane or crutch used on the opposite side of a painful knee or hip makes walking easier and helps the joint last longer.
  • Reachers are long rods with a grip handle on one end and a grabber on the other. They let you pick up small objects without having to bend over or reach uncomfortably.
  • Elevated chair legs make it easier to get in and out of your seat. The chairs you have can usually be fitted with extenders.

In the Kitchen & Bedroom:

  • Rearrange your kitchen so that the things you use most often are the easiest to reach.
  • Use lamps activated by touch or by your voice.
  • Getting dressed could be easier if you switch to big buttons, button hooks, or velcro closures.
  • Find sock aids and zipper pulls. A sock aid can help you pull up your socks without bending your legs. A zipper pull makes zippers easier to grab and zip.

In the Bathroom:

  • A tub bench or shower seat lets you bathe more comfortably and reduces the chance of falls.
  • Grab bars make it easier to get in and out of the bath and on and off the toilet.
  • A raised toilet seat with side rails reduces the strain of getting on and off.
  • Long-handled sponges help you to wash your legs and feet without bending.

 

Occupational Therapists specialize in helping older adults to safely perform activities and do the things they want to do.  Being able to perform basic self-care activities is very important for older adults to safely live independently. They may have other ideas for assistive devices or home modifications that could make a world of difference.  If you are having trouble with completing day-to-day activities, talk with your doctor about physical and occupational therapy to restore your mobility and function as soon as possible.