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Managing Physical/Occupational/Speech Therapy & Rehabilitation Care

Apollo Managed Care Consultants
January 2, 2011
636 Pages - SKU: APO6065651

Abstract Table of Contents Related Reports

This 2-volume compendium of detailed review criteria guidelines for adult and pediatric (outpatient and/or inpatient) therapy visits including modalities. The estimated number of visits to treat specific conditions with instruction for self-directed care are listed, as well as guidelines for adult and pediatric speech-language therapy, therapy-related DME, inpatient rehabilitation unit/hospital admission, continued stay, and discharge. Resources include the Oregon pediatric guidelines for rehab, example protocols, quality monitors, web sites and extensive authoritative references.

¨Introduction to rehabilitation services; Therapy referrals; Utilization management; Medical Necessity Criteria; Physical Medicine and Rehabilitation - Medicare; Physical Therapy/Occupational Therapy provided by physicians and physician employees; Maintenance therapy/ Medicare treatment parameters for medically necessary items/services; Therapeutic activities, direct (one on one) patient contact by the provider; Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and proprioception, Therapeutic trocedures; Therapeutic exercises to develop strength and endurance, range of motion and flexibility; Physical Therapy - Defined; Automobile Driving Therapy; Level of care for therapy; Teletherapy services; Orders;

Modalities - Review criteria for coverage of: Hot or cold packs; Traction, mechanical; Electrical stimulation, (unattended); Vasopneumatic devices for edema; Paraffin bath,; Microwave; Whirlpool or Hydrotherapy, Hubbard tank; Fluidotherapy/Fluidized Therapy; Diathermy/Diapulse; Infrared; Ultraviolet light; Cold/Soft Laser Therapy; Iontophoresis; Phonopheresis; Contrast baths; Ultrasound; Therapeutic Ultrasound for Wound Healing;

Guidelines for procedures including: Therapeutic exercises; Neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture and proprioception; Aquatic therapy with therapeutic exercises; Gait training; Massage, therapeutic; Manual therapy techniques - traction, soft tissue mobilization, manipulation, joint mobilization; Therapeutic procedures (group), Orthotics management & training; Prosthetics management & training; Therapeutic activities; Cognitive skills development; Sensory integration; Self-care/Home management training, Community work/Reintegration training, Training in Activities of Daily Living (ADLs), Wheelchair management/propulsion training; Work assessment, Work hardening; Transfer Training, Strength, Range of Motion , Pain Management, Other; Acupuncture; Biofeedback; 'Prehab';

Tests and Measurements; Physical performance test or measurement; Assistive technology assessment; Muscle and range of motion testing

Post-acute Care Therapy; Maintenance Therapy Criteria; Claims review for therapy services; Physical Medicine Guidelines for Duplicative Services; Occupational Therapy Services;

Neuropsychological Testing; Cognitive skills development; Sensory integration; Neurocognitive Therapy; Sensory Integration Therapy;

Pain; Chronic Pain Assessment and Treatment; Pain Rehabilitation Program review criteria; Outcome measures for chronic pain management; Headaches; Pharmacologic challenges for sympathetically maintained pain; Electrodynogram; Treatment Plan Modalities - including transfer training, strength, ROM, Pain management review policies; Evaluation (injury, exacerbation, re-injury, pain, strength definitions); Chronic Pain Assessment/Pain Centers;

Standing orders for therapy; Outcome management; Functional Independence Measures (FIM); Quality Improvement Guidelines/Outcome studies;

Gait Analysis, Computerized/Dynamic Electromyographic/Electrodynogram; Treadmill - evaluation and teaching use of;

Visit authorization Review Guidelines by Skeletal Structure

Introduction; Severity criteria by condition or system;

Spine: Lumbosacral spine; low back pain, acute and chronic; Disability periods/Return to work guidelines for lumbar disc disease/acute low back pain - by severity, type of treatment; Traction for low back pain; Back School Program, Manipulation of the spine under anesthesia; Low level heat wrap therapy; Lumbar spine, pre-surgical or non-surgical therapy visit recommendations: Lumbar spine, post-surgical therapy visits; Clinical guidelines: Magnet Therapy for low back pain,

Cervical spine, pre-surgical or non-surgical therapy visits; Clinical guidelines: TENS + therapy for chronic cervical pain; Cervical spine, post-surgical therapy visits; Clinical guidelines: Neck Pain,

Shoulder: pre-surgical or non-surgical, post-surgical therapy visits; Clinical guidelines: Total Shoulder - post-operative protocol, Rotator Cuff Repair/Impingement syndrome, Adhesive capsulitis, Ultrasound therapy for calcific tendinitis, shoulder,

Elbow: pre-surgical or non-surgical therapy visits; post-surgical, Lateral and medial epicondylitis, Wrist: pre-surgical or non-surgical, post-surgical, Carpal tunnel syndrome therapy;

Robotic-assisted rehabilitation of the upper limb after stroke;

Hand/fingers: pre-surgical or non-surgical therapy visits; post-surgical therapy visits; Clinical guidelines: Tenosynovitis/Flexor tendinitis involving the hand/fingers, Post Dupuytren’s Release OT,

Hip: pre-surgical or non-surgical therapy visits; post-surgical therapy visits; Clinical guidelines: Total hip replacement,

Knee: pre-surgical or non-surgical therapy visits; Clinical guidelines: Therapeutic Knee Taping - for osteoarthritis pain control; post-surgical therapy visits; Clinical guidelines: Iliotibial band syndrome; Patello-femoral syndrome, Osteoarthritis of the knee, Total knee replacement, post-op, Complete MCL tears rehabilitation program, ACL reconstruction rehabilitation protocol (Ventura), ACL reconstruction rehabilitation protocol (Appleton),

Ankle: pre-surgical or non-surgical therapy visits, post-surgical therapy visits, Clinical Guidelines: Achilles tendinitis, Ankle sprains/strains,

Foot/toes: pre-surgical or non-surgical therapy visits; Clinical guidelines: Foot/toes, post-surgical therapy visits; Clinical guidelines: Morton’s neuroma, Plantar fasciitis; Amputations, upper or lower extremities; Post-bunionictomy management protocol; Total Ankle Replacement Protocol;

¨Other conditions: Therapy visit recommendations for: Pulmonary, Parkinson’s, Postural Drainage Procedures and Pulmonary Exercises; Maintenance therapy; Cerebral Palsy; Foot drop; Hypermobility, Polymyalgia, Multiple Sclerosis; R. A.; Osteoporosis; Reflex Sympathetic Dystrophy (RSD); Deformational plagiocephaly (DP); Fibromyalgia; Botulinum Toxin Injections; Complex Regional Pain Syndrome; Pelvic floor muscle training (PFMT) & biofeedback for urinary or fecal incontinence; Pelvic pain in pregnancy - acupuncture and exercise therapies; Vulvodynia therapy;

Temporomandibular Joint (TMJ) Disorders; Chronic Fatigue Syndrome (CFS); Heart failure; Intermittent claudication; Visual Loss - Medicare Coverage of Rehab Services; Osteoarthritis; Parkinson's Disease; Normal Range of Motion, Hippotherapy/Therapeutic Horseback Riding/Equestrian Therapy.

¨Acute Inpatient Rehabilitation Services: Review criteria for admission to a rehabilitation hospital; CORF medical review policy; Critical illness - acute therapy; Inpatient assessment for rehabilitation potential;

Clinical conditions; Pre-Admission Authorization Review Rehabilitation Services, Continued Stay Review, Discharge Status Review and Criteria for discharge; Burn injuries; Case mix, severity and complexity measures; Home Health Caregiver/Patient Teaching Coverage; Constraint-induced movement therapy (CIMT);

Authorization criteria for admission, LOS, discharge (by diagnosis): Stroke, Outcome measures for stroke management; Robotic-assisted rehabilitation of the upper extremity post-stroke; Stroke scales in clinical use;

Cancer care rehabilitation; Spinal Cord Dysfunction, Dorsal/lumbar areas, Non-traumatic spinal cord injuries; Cervical, Amputation, lower extremities, Brain Injury, Functional Improvement Outcome Measures following Brain Injury, Femur Fracture and other entities; Cognitive Rehabilitation Therapy

¨ Pediatric rehabilitation - Levels of care: Rehabilitation Care; Length of Stay; Oregon Guidelines for Medically-based Outpatient Physical Therapy and Occupational Therapy for Children with Special Health Needs in the Managed Care Environment - also note the preceding Speech-Language therapy and other pediatric-related guidelines throughout the manual. ¨

Quality Improvement Plan - Indicators, Quality ‘flags’, Benchmarks,

¨ Chiropractic services; Osteopathic manipulation - utilization guidelines; Cognitive rehabilitation therapy; other

¨Rehabilitation Benefits - Skilled Nursing Facility Levels of Care, Skilled vs. Unskilled Services Criteria, PacifiCare of California, Skilled nursing criteria, Skilled Physical Therapy Services Criteria, Skilled Occupational Therapy Services Criteria, Skilled Speech Therapy/Pathology Services Criteria, Speech and Voice Therapy Authorization Visit Guidelines

¨Forms: Referral authorization review sheet instructions and example forms; Order sheets; Therapy Discharge Summary Report Form;

¨Durable Medical Supplies and Equipment and related therapy:

Pressure Reducing Support Surfaces - Introduction; Pressure Reducing Support Surfaces - Group 1; Pressure Reducing Support Surfaces - Group 2 and 3; Air Fluidized Beds; Communication devices; Augmentative Communication Devices/aides; Tracheo-esophageal voice prostheses, Indwelling; Communication Boards; Compression Garments in the Treatment of Venous Stasis Ulcers; Diathermy;

Orthotic (braces) and Prosthetic Devices; Corset used as hernia support; Dynamic Splints; Foot Orthotics; Shoes, Therapeutic; Magnetic insoles for plantar heel pain; Magnetic Pelvic Floor Stimulation (MPFS); Myoelectric prosthesis, upper extremity; Lower limb prosthesis, computerized; Prosthesis criteria: functional levels; Shoe inserts to relieve back pain in patients with leg length discrepancies; Splints, Strapping & Casting;

Wound Care Resources; Autologous blood-derived products for non-healing wounds; Electrical Stimulation/Electro-magnetic Therapy for the Treatment of Wounds: Chronic Stage III & IV Musculo-Cutaneous Ulcerations; Negative pressure wound therapy (NPWT); Pneumatic Compression Therapy - End-diastolic for extremity ulcers; Radiant Heat Wound Therapy Systems; Light Emitting Diode (LED) or Infrared Therapy; Hyperbaric oxygen therapy;

Lymphedema Pumps/Manual Lymph Drainage; Seat Lift Mechanisms; Standers, Boards and Tables; Therapeutic Shoes; Trapeze bars and other bed accessories; Upper extremity splinting, Splinting of the Upper Quadrant, Related Occupational Therapy/Physical Therapy Services; Pulsavac Coverage; Traction, Cervical; Traction, Low Back Pain; Wheelchairs, Power-type and Power-operated vehicles (POVs); Whirlpool, plus an extensive DME list of 290 additional supply and equipment items with coverage guidelines.

Electrical Stimulation Modalities: Neuromuscular electrical stimulation (NMES); Neuromuscular or Therapeutic electrical stimulation (TES); Treatment of motor function disorders with electric nerve stimulation; Transcutaneous electrical nerve stimulation (TENS); Relief Band; ‘Sympathetic Therapy’; Inferential current stimulation; Percutaneous electrical nerve stimulation (PENS); Pulsed electrical stimulation for osteoarthritis of the knee; Non-implantable Pelvic Floor Electrical Stimulator; Surface electrical muscle stimulation; Microcurrent Stimulation; Electrogalvanic Stimulators for Levator Syndrome; H-wave stimulation for the treatment of diabetic neuropathy;

Mobility Assistive Equipment: Strollers; Canes and crutches; Wheelchairs including power operated and accessory equipment;

¨Medical Management Issues: Post-injury Work Evaluation and Program, UM forms; PT/OT Order forms, Handicapped Access Guidelines

¨Home Exercise Programs and Patient Education Materials: Introduction; Rest, Ice, Compression, Evaluation (RICE) Therapy - for acute injuries; Shoulder Girdle Exercises for Thoracic Outlet Syndrome, Shoulder Muscle Exercises; Forearm Extensors Exercises for ‘tennis elbow’; Abdominal Exercises, Buttock (Gluteus maximus/medius) Muscle Strengthening; Hip Joint Exercises; Swiss or Stability Ball; Stretching Exercises for Plantar Fasciitis; Ankle sprains; Acute Knee Injury; Quadriceps muscle exercises; Cervical Exercises; Back Exercises; Crutch Ambulation Instructions; Stretching; What about exercise? - brochure/handout; Work Smarter, Not Harder - brochure/handout; Back Pain and Sciatica - educational brochure; Resistance training; Preventive physical activity regimens; Warm-up exercises to prevent injury - are they effective?; Exercise Equipment Coverage; Duties and responsibilities of an athletic trainer; Tai Chi;

¨Glossaries - Organizations for Health Care, Abbreviations and Acronyms, Definitions of Terms related to therapy

¨References - listed by affected area or topic

Web sites - web link resources related to Disabilities, Physical Therapy, Occupational Therapy and Rehabilitation ¨

Resources - Certification, accreditation, provider networks; Oregon Guidelines for Medically-based Outpatient Physical Therapy and Occupational Therapy for Children with Special Health Needs in the Managed Care Environment; Impairment/disability evaluation; Lengths of Stay - Rehabilitation; CMS, Pub 09, Rehabilitation Manual, Chapter II excerpts; CMS, Pub 10, Hospital Manual, Section 211, Inpatient rehabilitation; Medicare Benefit Manual, Chapt 1, 110. Inpatient Hospital Stays for Rehabilitation Care.

Volume II

¨Speech- language therapy review criteria and clinical guidelines, now Volume II of Managing Physical/Occupational Therapy & Rehabilitation Care - Link to Speech for the complete contents of this volume.

Managing Physical/Occupational/Speech Therapy & Rehabilitation Care

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