FOX J

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FOX / JJ / RC SITE VISIT
FOXREHAB.ORGP 877.407.3422F 877.407.4329
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HISTORY AND BACKGROUND

• Entering our 10th year of practice providing
  proactive, in home geriatric, Physical and
  Occupational Therapy
• Organization was started based on Foxs clinical
  observations that traditional models of home care
  therapies through Medicare Part A miss a
  significant portion of the aging community.

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HISTORY AND BACKGROUND

• Medicare Transmittal B-98-59, December 1998
  states that PTs OTs in private practice can
  provide Part B services in the individuals
  home allowing frail community dwelling older
  adults access to rehabilitation services in their
  homes.
• In 2006 Gitlin reports, older people with
  functional disabilities do not typically receive
  home care to address performance difficulties
  unless an acute medical episode or
  hospitalization, triggers a referral

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MISSION
The mission of Fox Rehabilitation is to provide
the highest quality rehabilitation to the
geriatric community with compassion and respect,
while promoting optimal function and meaningful
lives.
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A Unique and Novel Concept

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Proactive vs. Reactive
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OUR STAFF

• 240 full Time, salaried employees
• The key to good healthcare happy well trained
  clinicians
• Happy
• Staff morale division
• Bi annual anonymous staff morale surveying
• Equity Appreciation rights
• Well trained
• Advanced training in geriatrics
• Advanced training in management of patients
• with Cognitive Impairments
• 4 day orientation
• Journal / literature review meetings
• Mandatory continuing education
• (exceeds state regulations)
• competencies

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OCCUPATIONAL THERAPY

• What is
• Occupational Therapy?

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OT Educational Training

• Currently at the Doctorate Degree Level for all
  new clinicians
• 4-6 Clinical Internships
• Research Project
• State Licensing Exam
• Board Certifications

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Occupational Therapy

• Maximizes residents functional independence by
  addressing
• ADLs (Activities of Daily Living)
• Dressing, bathing, grooming, feeding,
  toileting,
• shower transfers, environmental modification
• IADLs (Instrumental Activities of Daily Living)
• Shopping, driving,
• meal preparation,
• money management,
• light household tasks

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Occupational Therapy

• Experts in home evaluation and home
• modification.
• Provide therapy and training to residents AND
• caregivers to increase independence and safety
  
• in home environment

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OT Evaluation

• Extended subjective interview with resident,
• family and caregivers
• Objective and functional testing are still
• appropriate as long as the resident can follow
  
• basic commands

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OT Evaluation

• Objective Tests and Measure
• ?ROM ?Vision
• ?Strength ?Sensation
• ?Pain ?Skin Integrity/Edema
• ?Coordination ?Vital Signs
• Functional Tests
• ?Balance
• ?Functional mobility
• ?Cardio-vascular Endurance/stamina
• ?ADLs Bed Mobility, Transfers,
• Dressing, Toileting, Bathing,
• Feeding

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WHERE WE TREAT

• In home / residential
• Independent / Assisted living
• Adult Day Care
• Long Term Care Consultation

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FULL COVERAGE

• New Jersey North and South
• Manhattan (4 boroughs)
• Eastern Pennsylvania and Pittsburgh
• Northern Delaware
• Fredericksburg Winchester, Virginia

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DOCUMENTATION

• 2 INTERNAL AUDITING SYSTEMS
• MEDICARE REGULATORY COMPLIANCE DEPT.
• QUALITY ASSURANCE AUDITING
• All clinical staff are audited 3 times per year
  on 9 random cases. Our ability to demonstrate
  clinical quality and skilled need through
  documentation are just 2 of the many areas
  evaluated. Staff are graded on a 0 to 3.0 scale.
  Staff not meeting minimum requirements of 2.65
  are referred to our Qualifications Division for
  internal training modules and follow up.

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DOCUMENTATION

• Evidence Based
• Objective Tests and Measures
• Functional Outcome Measures

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CODING AND BILLING

• Fox utilizes ICD 9 diagnosis and 97000 CPT coding
  combinations to describe and bill our
  interventions
• Fox performs all of its billing and collection
  functions in house
• Fox utilizes the Medicare Physician Fee Schedule

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MEDICARE

• Currently, Medicare does not recognize or posses
  ICD 9 coding and therefore does not reimburse for
  direct caregiver training
• Today, caregivers are trained through goals set
  in the patients plan of care and are
  billed/reimbursed by choosing a code (non
  specific to care giving) which most accurately
  describes the intervention being performed. For
  example

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MEDICARE

• An OT is training a care giver on how to assist
  with a care recipients ADL along with
  accompanying resistive behaviors
• Bill ADL 97535. The Medicare descriptor for
  97535 does not claim any reference to care giver
  training.
• Self care/home management training (ADL/IADL and
  compensatory training, meal preparation, safety
  procedures and instructions in use of assistive
  technology/technology devices) Direct one on one
  contact by provider.
• CPT 2008

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MEDICARE

• So.. here lies the problem
• Hours and hours of caregiver training
  interventions are currently being provided and
  documented though services are not being
  accurately represented in the claims data.
• No existing code to clinically and financially
  represent caregiver training.

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INTAKE
Fox has a full in house Intake Division which
receives and verifies all orders as well as
primary and secondary insurances.