Skilled maintenance therapy: Jimmo v. Sebelius revisited
By
Kevin Cezat
Sep 12, 2024
On January 24th, 2024, we marked the 11-year milestone of the landmark settlement in the Jimmo v. Sebelius Lawsuit. This pivotal event had profound implications for using skilled maintenance therapy to...
Pay for performance, medical necessity and Jimmo
By
Shelly Mesure, MS, OTR/L
Jun 04, 2014
Why would anyone mention value-based reimbursement, medical necessity and the Jimmo lawsuit in the same sentence? I feel they are all related, but it will be difficult to find the perfect balancing act...
Jimmo guidance: Document whether therapy is for restoration or maintenance before providing care
By
Tim Mullaney
Dec 20, 2013
In seeking Medicare reimbursement, skilled nursing facilities should not claim that therapy was to maintain a patient’s condition if documentation reflected only an improvement goal, according to...
CMS updates Medicare manual to reflect Jimmo settlement
By
Tim Mullaney
Dec 10, 2013
The Centers for Medicare & Medicaid Services has revised the Medicare Benefit Policy manual to clarify that skilled care and skilled therapy may be covered even for conditions that will not improve, per...
Determining medically necessary Medicare coverage
By
Colleen Toebe
Dec 05, 2014
Accurate and thorough nursing documentation is the crucial factor in determining medical necessity. As nursing leaders in long-term care, we are obligated to ensure that Medicare documentation standards...
‘Plateaued’ is not a medical description
By
Jean Wendland Porter
May 28, 2024
I’m starting to sound like a broken record (vinyl is coming back; the kids know what I mean), but I recently heard a therapist say the patient’s progress plateaued, so we have to stop therapy. Again. ...
Therapy should be more than productivity
By
Jean Wendland Porter
Apr 22, 2024
“I’m too sick for therapy today.” “Come back later.” “Leave me alone.” If you’ve worked in long-term care (or hospitals or LTACHs or acute rehab hospitals), you’ve heard...
Jimmo v. Sebelius, 10 years later
By
Renee Kinder
Sep 14, 2023
In 2013, the Center for Medicare Advocacy and Vermont Legal Aid, along with additional counsel provided by Wilson Sonsini Goodrich & Rosati, settled a lawsuit with the Medicare program (the named defendant,...