Have you seen any Medicare payment denials when the patient moves in and out of hospice and/or palliative care and is being treated by physical therapy?
Answer
If a patient left hospice and then came back into palliative care, as long as the documentation can justify why skilled therapy services were needed, there should be absolutely no issues with insurance denials. This is because according to the Jimmo versus Sebelius settlement, as long as it's skilled therapy services are needed to maintain or slow the decline, then it(physical therapy) should be appropriate.
Chris Wilson, PT, DScPT, DPT, GCS
Chris Wilson PT, DPT, DScPT is an Associate Professor and Director of Clinical Education in the Physical Therapy Program at Oakland University in Rochester, Michigan, and was the founding Residency Program Director for the Beaumont Health Oncology Residency, the first accredited residency program for physical therapists in the United States. His clinical focus is Acute Care Oncology and Palliative Care. He is active in clinical research in the areas of Oncology, Hospice/Palliative Care, and Geriatrics. Dr. Wilson received his Doctor of Science from Oakland University. He received his transitional DPT from the University of St. Augustine with a Primary Care Certification and his Masters in PT from Oakland University. He has been Board Certified as a Geriatric Clinical Specialist since 2008. Chris has been awarded the Flomenholft Humanitarian Award from the Academy of Oncologic Physical Therapy in 2022 and the Signe Brunnström Award for Excellence in Clinical Teaching in 2015 from the American Physical Therapy Association. Dr. Wilson is a prolific writer and researcher. He published the book entitled Physical Activity and Rehabilitation in Life Threatening Illness by Routledge in 2021 and is the co-editor of the forthcoming textbook entitled Oncology Rehabilitation: A Comprehensive Guidebook for Clinicians to be released by Elsevier in Fall 2022. He has published over 35 full-length peer reviewed articles and many invited publications. Chris was the primary author and sponsor of the APTA’s positions on hospice/palliative care, diet and nutrition, and medical necessity in the presence of declining conditions.
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