This is Part 1 of Thriving in Skilled Nursing. We could spend a whole day speaking about the issues specific to the skilled nursing environment. My hope is to lay a strong foundation in regards to the regulatory background specific to the skilled nursing environment. Part 2 will delve more into interdisciplinary team practice and issues, restorative versus maintenance-based plans, goal writing and treatment plan development.
Providing skilled speech therapy services to the geriatric Medicare beneficiaries begins, of course, with having adequate understanding of the regulatory requirements specific to this population. This session will describe services that meet the criteria for reasonable and necessary services per the Medicare Benefit Policy Manual. We will clarify documentation requirements related to baseline versus prior level of function, and we will outline key differences between restorative versus maintenance-based interventions. We are going to describe the criteria that are outlined within the Medicare Benefit Policy Manual; specifically chapter 15, section 220. I am saying this because all of the regulations that guide the services we provide to Medicare beneficiaries are clearly outlined. The information is readily available to everyone to view. There is a lot misconception and misinformation in regards to Medicare regulations. Just to make everybody aware, they are always there for you to refer to if you ever have a specific question.
What are the objectives specifically for this course? We want to define reasonable and necessary care per the Medicare Benefit Policy Manual. We want to describe essential documentation requirements for documenting functional change between baseline and prior level of function. The reason I wanted to do this in Part 1 is because these ideas of “baseline” versus “prior level of function” can be pretty novel if clinicians are transferring from other settings into the skilled nursing facility (SNF) environment. I want to provide a good understanding of what that truly means. If your documentation ever went under medical review, what are reviewers specifically going to be looking for? Our third objective is to discuss the best practices for developing and documenting restorative and maintenance-based plans.