Skilled Therapy

montecarlo64, ASN, BSN, LPN · Sep 22, 2011

Skilled services are either skilled therapy services: PT, OT, or ST 5 days per week or a skilled nursing service such as IV therapy, injections, unstable medical condition, wound care, respiratory problems, feeding tubes, traches which are provided 7 days per week. EOT needed if therapy (pt,ot, st) services are discontinued and skilled nursing services continue. COT only involves those who are receiving therapy services and there is a change in there therapy level (ultra high to very high, etc.) EOT or COT not required if patient being skilled for nursing services and not therapy services..Confusing, but I hope that helps:)

susanthomas1954 · Sep 28, 2011

You only do a EOT/CoT, etc if the rehab RUG level changes. If your patient has 720 minutes on the 5 day, done on day 8, and only has 719 minutes on day 15, then you gotta do the CoT to reflect that it went from Ultra to Very in that period.

You gotta check your minutes daily, so that your patient has the same level of therapy this Friday, as they did last Friday. If not, you have to do the CoT, including all the interviews. Then, when they are back at 721 NEXT Friday, you do it all over again, even though the 30 day isn't due for two weeks. Patients see my office mate coming down the hall and they yell, "Sock, blue, bed!" They see me and scream "5!, My worst pain has been a 5!" The interviews are way over used. Sock, blue and bed are now testing long term memory in over half our patients/residents.

ST

susanthomas1954 · Sep 28, 2011

BTW, gotta keep an eye on the ADL charting, too, because that can change the rehab RUG as well.

ST

andy3k · Sep 28, 2011

BTW, gotta keep an eye on the ADL charting, too, because that can change the rehab RUG as well.

ST

Keep the following in mind:

CMS says "8. Clarification regarding the consideration of ADLs as part of the COT evaluation process.

Answer: Changes in ADLs do not constitute in and of themselves a change in the therapy category and should not be considered as part of the COT evaluation process. Although ADLs are not considered when determining whether a COT OMRA is required, they will be included in the calculation of the RUG score if a COT OMRA is performed."

Why do ADLs not constitute in and of themselves a change in the therapy category?

CMS says "2. Clarification regarding when a COT OMRA is necessary.

Answer: A COT OMRA must be completed in cases where the intensity of therapy provided during the COT observation period is not reflective of the therapy category into which the resident is currently classified. For example, if a resident classified into Rehabilitation Very High and then receives more than 720 reimbursable therapy minutes during the COT observation period, then a COT OMRA would be necessary to categorize the resident into Ultra High Rehabilitation (assuming all other qualifiers for this category are met.)"

Note that is says therapy category. There are multiple RUGs in each category, affected by ADL, but the COT OMRA is only completed for changes in therapy category.

CMS says: "7. Clarification regarding the term "therapy category".

Answer: The term "therapy category" refers to the ten major therapy divisions, which are

Ultra High Rehab Plus Extensive, Very High Rehab Plus, Extensive,

High Rehab Plus Extensive, Medium Rehab Plus Extensive,

Low Rehab Plus Extensive, Ultra High Rehab,

Very High Rehab, High Rehab,

Medium Rehab, Low Rehab"

Source: https://www.cms.gov/SNFPPS/Downloads/Provider_Call_FollowUp082311.pdf