Frequently Asked Question of the Month:
What is maintenance therapy and is it covered under the Home Health benefit?
Maintenance therapy is defined as skilled therapy services required to maintain the patient’s current condition or to prevent or slow further deterioration.
Coverage of therapy services to perform a maintenance program is not determined solely on the presence or absence of a beneficiary’s potential for improvement from the therapy, but rather on the beneficiary’s need for skilled care. Assuming all other eligibility and coverage requirements are met, skilled therapy services are covered when an individualized assessment of the patient’s clinical condition demonstrates that the specialized judgment, knowledge, and skills of a qualified therapist are needed to:
- Establish a maintenance program or
- Design a maintenance program
OR
An individualized assessment of the patient’s clinical condition demonstrates that the specialized judgment, knowledge, and skills of a qualified therapist or by a qualified therapist assistant under the supervision of a qualified therapist (“skilled care”) are necessary for: - The performance of a safe and effective maintenance program
When the performance of a maintenance program does not require the skills of a therapist or of a qualified therapist assistant under the supervision of a qualified therapist because it could safely and effectively be accomplished by the patient or with the assistance of non-therapists, including unskilled caregivers, the patient is not in need of and does not qualify for maintenance therapy.
Symbria is committed to maintaining a high standard and level of communication with our clients and employees regarding clinical education, PDGM understanding, patient assessment, home health regulations, and coding efficiency. As a result, the Home Health Insider was born. In this monthly offering, we hope to provide some valuable information that can foster a quality level of care that meets the needs of the patients that we serve.