OASIS Alert
Must You Deny Needed Therapy?
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Patient care and Medicare payment can depend on understanding the term "qualifying." True or False: Occupational therapy can be a qualifying service on recertification, even though the need for OT wasn't identified until the end of the original episode, after skilled nursing and physical therapy had completed providing services. Answer: True. This situation is confusing for many clinicians because OT cannot qualify the patient for the Medicare home health benefit in the original episode of care. Only SN, PT or speech language pathology can do that.
But once an agency establishes a qualifying service, if the patient has a continuing need for OT after the agency has discontinued other skilled services, OT can become a qualifying service, Cahaba GBA says in its March Home Health and Hospice Medicare A Newsline. And as a qualifying service, OT would allow dependent services such as a home health aide, Cahaba adds.
Note: For the Cahaba response, go to www.iamedicare.com/Provider/newsroom/newslines/newslines_hha.htm.
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