Therapy TPE Audits Lead to Home Health Denials
Did you know that National Government Service (NGS) is focusing one of the home health Targeted Probe and Educate on therapy utilization?
NGS is auditing home health rehab service concentrating on medical necessity, the timeliness of the 30-day reassessments that is performed in conjunction with an ordered therapy service, and the required reassessment content by each rehab discipline. For many of the denials, the reasons stem from the therapist not comparing the present assessment results to prior assessment measurements and failing to document the effectiveness of therapy, or lack thereof, as required by regulation.
It may be beneficial to review with your therapy staff the key components to the therapy reassessment documentation as outlined by CMS.
- Each rehab discipline must document measurement results of functional reassessment compared to prior measurements
- Each must also document why therapy should be continued or, if applicable, discontinued
- Document therapist’s determination of effectiveness of therapy
- Why therapy is beneficial?
- Why does the patient need more?
- Remember the re-assessment is only one component of the home visit; there must be evidence of an ordered intervention as well.
- Document treatment performed the day of re-assessment
- Re-assessment without care plan interventions is a not covered service
Be Aware…
If measurement results do not reveal progress toward goals and/or do not indicate that therapy has been effective — then, to continue therapy — there must be consultation with the physician and documentation showing why the therapist and physician determined therapy should be continued.
Don’t forget to confirm continuation of the therapy with the verbal order!
I hope to hear from folks who are experiencing any of these issues with the therapy TPE.
Many home health care agencies (HHAs) have contacted me over the past few weeks with questions about the Targeted Probe and Educate (TPE), so I thought I would review the rules because I am sure others have the same questions. NGS has contacted HCA to let us know that there are new TPE audits in Massachusetts: high therapy utilization, long lengths of stay, documentation supporting homebound for Heart Failure, COPD, Diabetes and Dementia, and medical necessity.
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