You may have heard that the Centers for Medicare & Medicaid Services (CMS) is closing the Concurrent Therapy loophole on October 1, 2010? What is Concurrent Therapy: some therapy departments (managed by in-house or contract therapy companies) have relied on the use of concurrent therapy: “concurrent therapy is the practice of one professional therapist treating more than one Medicare beneficiary at a time — in some cases, many more than one individual at a time”. Concurrent therapy is distinguished from group therapy, because all residents are not on common skill development and are working on different goals and task. In a group therapy setting the residents are working on common skill development and tasks. In a group setting the ratio of participants to therapists may be no higher than four to one.”
CMS has further stated “A beneficiary who is receiving concurrent therapy with one or more beneficiaries likely is not receiving services that relate to those needed by any other participants. Although each beneficiary may be receiving care that is prescribed in his individual plan of treatment, it is not being delivered according to Medicare coverage guidelines: that is, the therapy is not being provided individually, and it is unlikely that the services being delivered are at the complex skill level required for coverage by Medicare.”
The new RUG IV and MDS 3.0 regulations, that go into effect October 1, 2010, state that concurrent therapy of two (2) patients at a time will be allowed, concurrent therapy must also be documented separately (on the MDS) from the individual one-on-one and group therapy time.
So what is the concurrent therapy loophole? Some therapy departments (in-house and contract managed) transitioned from one-on-one therapy to “concurrent” therapy, under this method one professional therapist works with multiple residents on different therapy tasks at the same time, but they still bill Medicare as if each resident received 100% of the therapist’s attention. For example, SNF Medicare reimbursement rules have allowed a therapist treating four patients concurrently during the course of one hour to bill Medicare for four full hours of therapy. CMS reports that more than a quarter (28.26%) of therapy provided in SNFs is now concurrent. CMS will close this loophole when it implements the RUG IV and MDS 3.0 revisions to Medicare by requiring allocation of concurrent therapy time and by limiting concurrent therapy to two residents.
Concurrent therapy scenarios:
…a therapist has been told that he/she must treat 16 residents in the morning (4 hours) and provide the therapy services “concurrently” four residents at a time….
…a therapist is told that the policy is to treat all residents concurrently and record the total minutes for all patients. For instance, the therapist has been told to provide 1 hour of concurrent therapy to four patients who are working on different goals and record 60 minutes of therapy for each.
Things to consider….
- Are the residents receiving appropriate care?
- How can their individual needs and goals be effectively and consistently addressed in the above scenarios?
- How will therapy departments that have high utilization of concurrent therapy adapt to the new rules and regulations of concurrent therapy?
- If a multi-facility organization has a high utilization of concurrent therapy, for them to maintain the same level of therapy under the RUG IV regulations how many more therapist will they have to hire?
- Would not true “One-on-One” therapy be the best for the resident, therapist and provider?
Long Term Care Rehabilitation 