Evolving Our Brand to Reflect the Value We Deliver
This new brand makes it easier for healthcare providers to recognize our ability to seamlessly support them in turning a challenge into an opportunity while maintaining fiscal responsibility and compliance.
- Encore is a trusted, dependable partner who puts clinical and compliance first.
- Encore supports our clinicians with cutting edge tools, resources, education, and marketing support so that our partners can achieve their organizational objectives.
- Encore delivers patient outcomes that improve lives.
We deploy a three-level approach to tailor our suite of best-in-class resources to your specific budget, needs, and objectives that ensures each member of your team is aligned with and supported by their most valuable Encore counterpart.
Partnering to Improve the Future
- Level 1 – Leadership
- Leaders at each of our more than 550 partner locations enjoy one-on-one relationships with an Encore Regional Vice President.
- You are further supported by experienced recruiters and staffing coordinators.
- Level 2 – Frontline
- Your frontline team members have access to a local management team and therapy team.
- Your Encore team is available to attend facility meetings and meet all patient needs.
- Level 3 – Documentation, Data Analytics, Reporting & Appeals
- We review all documentation of therapy services regularly to ensure adherence to Medicare and
state guidelines. - Our enterprise-level electronic billing system integrates daily financial and clinical data.
- We stand by the care we provide and fight for the therapy your patients deserve.
- We review all documentation of therapy services regularly to ensure adherence to Medicare and
Denial Trends
Providing quality patient care is at the forefront of what we do as health care professionals. While that is the most elemental component, services also have to be billed in order to continue to function as a business organization. If the components aren’t present to support what is billed for the dedicated services being administered, facilities are at risk for lesser payments, takebacks, or outright denials.
- 1) Authorization
- 2) MDS coding not supported by clinical documentation negatively impacting PDPM case mix assignment
At times, denials citing lack of authorization can occur even if authorization has been obtained, or in some cases, was not even required. When those occur, the Encore Appeals Management Specialists can address them through the appeal process. The issue becomes more complex and difficult to pursue payment on, when authorization was in fact required, but not obtained. It is important that all members of the Interdisciplinary Team (IDT) at the facility are aware of the necessity of verifying each patient’s payer source and plan specific authorization requirements. IDT members should:
- Be aware of managed care contract terms and limitations. These may change without notice from the insurer so it’s imperative to check prior to providing services.
- Clearly designate who is responsible for obtaining needed authorizations, and follow up with the designee for outcomes so the IDT is aware of what is covered or not.
- Include the authorizations in the medical record if possible. This can improve IDT awareness of auth designations and accelerate the appeals process when easily accessible to obtain payment more expediently.
- Include authorization numbers on the claim when billing for applicable services.
- Stay in the loop by regularly monitoring for any policy changes by insurance companies, which are often communicated via different platforms (e.g. newsletters, emails, company website, etc.).
Denials due to the documentation lacking support for coding of certain items on the MDS can occur if the requirements set forth in the Centers for Medicare & Medicaid Services’ Long-Term Care Facility Resident Assessment Instrument (RAI) User’s Manual are not recognized. With the broader categories for payment under PDPM, increased scrutiny is taking place to determine if coding is appropriate on the MDS for some factors that impact payment amounts, especially nursing and non-therapy ancillary services. Common areas of denial, citing the components are not supported in documentation, are:
- Section I:
- I0020: primary diagnosis code
- Should represent the physician documented
primary reason for the stay. The MDS Manual
gives some examples for reference.
- Should represent the physician documented
- I5600: Malnutrition diagnosis
- Consult with the dietician/nutrition services and physician to determine if the condition is related to the patient’s current status/care during the 7 day lookback and that it is physician documented in the last 60 days.
- I0020: primary diagnosis code
- Section O0100M: Isolation coding
- Presence of single room isolation with all treatments in room because of active infection above standard precautions.
- Section J1100C: Shortness of Breath when lying flat
- Documentation must be present within the 7 day lookback if SOB is present when lying flat or if the patient avoids lying flat because of SOB. The presence of a chronic respiratory diagnosis does not suffice. If ascertained by interview, the interview must be documented and take place during the lookback period, not after.
- Section GG0100: Section GG
- Record of patient’s usual status (not best/worst/potential) based on direct observation, reports, and resident and family reports during the first 3 days of the stay; data should be collected in collaboration with nursing and therapy, signed and dated by the clinician collecting the data, and support all section GG payment items.
Parkinson’s Disease and Occupational Therapy Interventions
There are more than 1 million people in the U.S. living with Parkinson’s Disease (PD) and more than 10 million people worldwide. Approximately 60,000 people in the U.S. are diagnosed each year and experts estimate this number will grow based on several factors including population growth, people living longer, and improved PD recognition and diagnosis. It is estimated that Parkinson’s Disease affects 1% of the population over the age of 60 and is the second most common degenerative neurological disorder after Alzheimer’s disease.
Although the prevalence of Parkinson’s Disease is high, not all is doom and gloom. It is possible for those with Parkinson’s Disease to maintain an active lifestyle by making positive and healthy choices, receiving medical assistance, and obtaining support from friends, family, and their community.
Within the skilled nursing setting there are a number of things the interdisciplinary team can do to help make the lives of our residents full and meaningful. Since April is both Occupational Therapy Month and Parkinson’s Awareness Month, our focus today is on what OTs can do to promote quality of life for those with PD within the SNF setting.
There are 5 Stages of Parkinson’s Disease. OT intervention can positively impact individuals in each stage of the process. OTs are trained in modifying tasks to help individuals perform activities whether through movement strategies utilizing adaptive devices or by modifying the environment. It is the goal of OT to help enable residents maintain their usual level of self-care and leisure activities for as long as possible. When it comes to working with those with Parkinson’s Disease, OTs are consistently problem solving throughout the course of care to empower everyday living.
- Stage 1: Mild symptoms, usually present with a tremor in one limb
- OT intervention: home safety education, PD
resources, home exercise program
- OT intervention: home safety education, PD
- Stage 2: Symptoms are bilateral, posture and gait affected
- OT intervention: ADL safety and compensatory training, toileting safety & strategies, continence program
- Stage 3: Significant slowing of body movements, early impairment of equilibrium
- OT intervention: ADLs, bathroom equipment such as tub bench, shower chair, adapted feeding utensils
- Stage 4: Rigidity and slowness of movement, tremor may be less than earlier stages
- OT intervention: Need for bathroom equipment, assist with ADLs, bed and/or wheelchair positioning
- Stage 5: Weight loss, muscle loss and/or weakness, appetite loss, and fatigue
- OT intervention: caregiver education, passive
range of motion, bed positioning
- OT intervention: caregiver education, passive
Working together in our SNF communities, we can offer interventions and activities to individuals which will enable those with Parkinson’s Disease to live life to its fullest. Activities such as singing, dancing, Tai Chi, mindfulness activities, meditation, group engagement events, and otherwise, will help our seniors maintain the quality of life that they deserve.
For additional information on how your SNF community can make a difference in the lives of those with Parkinson’s Disease, please see the resources below.
American Parkinson Disease Association:
www.apdaparkinson.org
Parkinson’s Foundation:
www.parkinson.org
Parkinson’s Resources:
www.parkinsonsresources.org
-Encore Rehabilitation’s monthly publication, designed to give you updates on trends we are seeing in the Post-Acute Care industry.-
