In 2007 Medicare issued no new transmissions that altered the technical language of the Benefits Policy Manual.
In 2008 there will likely be one transmittal in February that will alter the language of the Benefits Policy Manual. The alteration mainly deals with the new ninety (90) day re-certification period.
Nevertheless, the myth among many physical therapists and physical therapist assistants is that Medicare changes every year and, as a result, there is no way to understand or to predict the seemingly random and haphazard changes in the rules.
I've noticed this belief among physical therapy students and physical therapy educators. There appears to be a reluctance to instruct students in the basic requirements to treat Medicare patients.
These requirements are the folowing:
- Demonstrate the Medical Necessity of Physical Therapy
Demonstrate that you expect the patient to recover significant function in a reasonable time frame.
Demonstrate skilled physical therapy services.
If new graduate physical therapists and educators focus instead on the process of physical therapy diagnosis and on the needs of the patient then the technical requirements for treating Medicare patients may seem less burdensome.
The patients’ needs never change
While the technical requirements of treating the Medicare beneficiary do change and these changes seem to have less to do with physical therapists’ job demands and more to do with policy or political machinations at the national level it is important to remember that the patients’ needs never change.
The premise of the SIMPLE system is physical therapy diagnosis leads to good documentation and that ongoing assessment requires a written record of prior measurements.
Goal setting and the selection of interventions is a logical, predictable process predicated on the findings in the evaluation.
Physical therapy diagnosis is a process, not an event.
The initial diagnosis is often based on incomplete data that may be refined or changed by the time the discharge note is written. The diagnosis in the discharge note may be the same or it may be entirely different from the initial diagnosis.
When physical therapists understand that Medicare pays for (and demands documentation that demonstrates) the ongoing assessment and ultimate diagnosis of the physical therapist then the technical changes are less relevant to the process.
The process never changes.
