The Amplify OT Podcast Clarice Grote, MS, OTR/L

Fall 2023 Amplify OT and Healthcare Policy Updates {Bonus Episode}This bonus episode is outside of our regularly scheduled content but I wanted to pop in and give you some updates and let you know about policy changes going into effect. 
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As an exclusive bonus for podcast listeners, you can join the Amplify OT Membership at any time! Join today to take control of your career! It’s time to become your own best resource on Medicare and advocacy.

The updates I cover in this episode include:
Amplify OT updates: membership enrollment open, programs available for students, OT Amplifier series, prompted journals.  Kevin McCarthy was removed from his position as Speaker of the House of Representatives creating a temporary pause in the passing of legislation before being replaced by Mike Johnson.Open enrollment is approaching for both Medicare and commercial insurance plans and CMS has implemented policies to review all Medicare Advantage promotional materials for misleading information before they air.We have had the largest healthcare worker strike in US history and looking at the implications and results of this is interesting to sink into.

Amplify OT ResourcesWant to keep learning about how insurance and reimbursement impact you? Then head to AmplifyOT.com/Services to see what resources we have available!


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Helpful Links
The Daily- NYTNPR - Breaking News, Analysis, Music, Arts & Podcasts : NPRThe Weeds - VoxKFF Health News: What the Health?Pulse Check podcast - POLITICOAmplify OT Products on AmazonAOTA Education Summit 2023How to Teach OT and OTA students Medicare and Health Systems • Amplify OTPOLITICO: CMS Rejects More Than 300 Medicare Advantage Adsa...

Medicare and Medicaid Policy Updates: RUGS, PDPM, MDSIs Medicare No Longer Paying for OT in SNF?I’ve seen a lot of concern on social media and in my DMs about potential significant changes to PDPM in Skilled Nursing Facilities, specifically around Medicare no longer paying for OT in SNF. You can rest assured that there have NOT been any major changes to Medicare Part A for therapy but other changes have been made. That’s why this week on The Amplify OT Podcast, I am talking about updates to PDPM in Skilled Nursing Facilities (SNF) and when these changes are set to take place.

Join the Amplify OT Membership
As an exclusive bonus for podcast listeners, you can join the Amplify OT Membership at any time! Join today to take control of your career! It’s time to become your own best resource on Medicare and advocacy.

The updates I cover in this episode include:
CMS finalized that it will no longer support the utilization of RUG payments for Medicaid programs. There have not been any cuts to Medicare Part A SNF funding but rather a 4% increase. Removal of Section G (former ADL section), integrating some items into Section GG (function and self-care).The changing of quality measure scores. Changes and modifications around COVID-19 policies. ICD 10 Code mapping changes for Parkinson's and COVID-19.

Amplify OT ResourcesWant to keep learning about how insurance and reimbursement impact you? Then head to AmplifyOT.com/Services to see what resources we have available!


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Helpful Links
Medicare.gov Care CompareAOTA: Major Changes to the Minimum Data Set in Skilled Nursing Facilities Fiscal Year (FY) 2024 Skilled Nursing Facility Prospective Payment System Final Rule - CMS-1779-F | CMSOccupational Therapy in Skilled Nursing FacilitiesAmplify OT: SNF Resources Ep 5: Patient Driven Payment Model (PDPM) in Skilled Nursing Facilitiesa...

When OT Can Stand Alone in Home HealthHow many visits does another qualified practitioner have to complete before occupational therapy can stand alone for a Medicare home health patient? This is a question I got asked more than once and wanted to take the time to get to the bottom of this question and address some of the myths around the order of service. That’s why this week on The Amplify OT Podcast, I am breaking down the criteria for OT to stand alone in home health.
Join the Amplify OT Membership
As an exclusive bonus for podcast listeners, you can join the Amplify OT Membership at any time! Join today to take control of your career! It’s time to become your own best resource on Medicare and advocacy.
In this episode, I cover:
Reviewing the definition of a qualifying service in Medicare Part A.What it means to be able to “stand alone” in home health.Breaking down the policy and answering the question: ow many visits does another qualified practitioner have to complete before occupational therapy can stand alone for a Medicare home health patient?Whether or not it matters what order the therapies go in in order to qualify for home health. Instances where agencies may be hesitant to allow OTs to initiate the start of care.
Amplify OT ResourcesWant to keep learning about how insurance and reimbursement impact you? Then head to AmplifyOT.com/Services to see what resources we have available!


CLICK HERE to save 40% off Medbridge Today!


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Helpful Links
Home Health Playlist • Amplify OTUltimate OT Skilled Nursing Facility (SNF) and Home Health Guide • Amplify OTAmplify OT • Is OT a Qualifying Service in Home Health?Amplify OT: Can Occupational Therapists Perform the SOC OASIS?Amplify OT • What is PDGM in Home Health?




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Mentioned in this episode:
Join the Amplify OT Membership
As a exclusive bonus for podcast listeners, you can join the Amplify OT Membership at any time! Join today to take control of your career! It’s time to become your own best resource on Medicare and advocacy.

Join the Membership Today
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Diving into Deductibles: Untangling the Complexity of Health Insurance PricingDeductibles are an important, yet often misunderstood factor in the American health insurance system. I recently got asked a question from someone wondering if we truly have our health insurance if it doesn't kick in until our deductible is paid. That’s why this week on The Amplify OT Podcast, I am breaking down the reasons deductibles are incorporated into our health insurance plans!
Join the Amplify OT Membership
As an exclusive bonus for podcast listeners, you can join the Amplify OT Membership at any time! Join today to take control of your career! It’s time to become your own best resource on Medicare and advocacy.
In this episode, I cover:
The difference between a premium and a deductible. The moral hazard and financial hazard arguments as to why we must pay a deductible on our health insurance.The current and ongoing debate over deductibles happening in Congress.

Amplify OT ResourcesWant to keep learning about how insurance and reimbursement impact you? Then head to AmplifyOT.com/Services to see what resources we have available!


CLICK HERE to save 40% off Medbridge Today!


CONNECT WITH AMPLIFY OT:
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©Amplify OT
Mentioned in this episode:
Join the Amplify OT Membership
As a exclusive bonus for podcast listeners, you can join the Amplify OT Membership at any time! Join today to take control of your career! It’s time to become your own best resource on Medicare and advocacy.

Join the Membership Today
Medbridge Ad Link
Need CEUs? Save 40% off on your Medbridge subscription by using code “AmplifyOT” at checkout. Medbridge has great CEUs on Medicare, Reimbursement, and leadership! By using our affiliate code "AmplifyOT" at checkout you support this podcast and our continued work. Thanks for supporting Amplify OT! https://www.medbridgeeducation.com/amplify-ot
CLICK HERE to save 40% off Medbridge Today!

Billing for Point of Service (POS) DocumentationQuestions around billing are ones I get asked quite often and like any other type of billing, billing  for point of service documentation can be tricky to navigate. The main reason I find that people want to include their documentation or chart review time in their billable time is not that they are purposely trying to defraud someone or do something illegal, but it's typically because they just want their job to recognize the work they did. That’s why this week on The Amplify OT Podcast, I am talking about billing for point of service (or POS) documentation!

Join the Amplify OT Membership
As an exclusive bonus for podcast listeners, you can join the Amplify OT Membership at any time! Join today to take control of your career! It’s time to become your own best resource on Medicare and advocacy.

In this episode, I cover:
How to advocate for yourself if your employer is pressuring you to report minutes in the billing section that are spent documenting or chart reviewing and not with a patient.Instances where you can and cannot bill for documentation time.The main question you need to ask yourself to determine whether or not you can bill for your POS documentation. Examples of instances where billing for point of service documentation is necessary and when it may be inappropriate. Why you cannot bill for documentation or chart review time when you are not with the patient.

Amplify OT ResourcesWant to keep learning about how insurance and reimbursement impact you? Then head to AmplifyOT.com/Services to see what resources we have available!


CLICK HERE to save 40% off Medbridge Today!


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LINKS MENTIONED IN THIS EPISODE:
MDS 3.0 RAI Manual v1.17.1_October 2019 - reference Page 507 Therapy Minutes11 Part B Billing Scenarios for PTs and OTs | CMS
Links to IG Reels on Billing
https://www.instagram.com/reel/Cw8AAgXuQRJ/https://www.instagram.com/reel/Cw8QWX3xkFU/a href="https://www.instagram.com/reel/Cw8hUUfx54A/" rel="noopener noreferrer"...

Doing Your Due Diligence as a Licensed OT Practitioner with Raphie WagnerYou hear me preach on the podcast all the time about doing your due diligence in order to protect your license. We’re going to drive this point home in today’s episode as our guest, Raphie Wagner learned firsthand the consequences of not doing her due diligence as an OT. That’s why this week on The Amplify OT Podcast, I am talking about doing your due diligence as a licensed OT practitioner.

Join the Amplify OT Membership
As an exclusive bonus for podcast listeners, you can join the Amplify OT Membership at any time! Join today to take control of your career! It’s time to become your own best resource on Medicare and advocacy.

In this episode, Raphie and I cover:
How Raphie’s lengthy career as an OT in many settings has shaped her perspective of the profession as a whole.Doing your own due diligence on policies and license requirements, NOT just trusting your employer in doing theirs.   The mistake that cost Raphie $20,000, countless hours, and a disciplinary action that is connected to her license still to this day. A word of caution for any new grads considering entering into the travel space.Having your own liability insurance to fall back on to protect yourself. The huge importance of getting involved in your state association.

Amplify OT ResourcesWant to keep learning about how insurance and reimbursement impact you? Then head to AmplifyOT.com/Services to see what resources we have available!


CLICK HERE to save 40% off Medbridge Today!


CONNECT WITH AMPLIFY OT:
WebsiteServicesFree NewsletterInstagramLinkedInFacebookTikTok

CONNECT WITH RAPHIE WAGNER:
Instagram @otraphie 






©Amplify OT
Mentioned in this episode:
Medbridge Ad Link
Need CEUs? Save 40% off on your Medbridge subscription by using code “AmplifyOT” at checkout. Medbridge has great CEUs on Medicare, Reimbursement, and leadership! By using our affiliate code "AmplifyOT" at checkout you support this podcast and our continued work. Thanks for supporting Amplify OT! https://www.medbridgeeducation.com/amplify-ot
CLICK HERE to save 40% off Medbridge Today!
Join the Amplify OT Membership
As a exclusive bonus for podcast listeners, you can join the Amplify OT Membership at any time! Join today to take control of your career! It’s time to become your own best resource on Medicare and...