Providing physical therapy services in the home health setting involves creativity, flexibility, and solid documentation skills. Physical therapists (PTs) need to employ their full scope of assessment skills in order to manage a medically complex individual without the support of a medical facility or quick access to individual staff.1
The legal and professional responsibility associated with documentation is an essential component of home health physical therapy. PTs must stay current with continuously changing regulations and laws regardless of payer source. According to the Home Health Section of the American Physical Therapy Association (APTA), home health care is a medically oriented, skilled, and intermittent service provided in the home that may include nursing, physical therapy (PT), occupational therapy, speech therapy, social services, dietary/nutrition counseling, pharmacy services, and/or home health aides.2 Home health services are typically provided for individuals who meet homebound criteria. Patients are most often senior citizens, disabled persons, or children with variety of diagnoses including orthopedic, neurological, cardiovascular, medical and other. Patients are typically restricted to an environment such as the patient's home, caregiver's home, assisted living facility, skilled nursing facility in extended care beds, group home, residential facility or the like. Home health offers more autonomy than other settings in which a PT is rendered and provides needed services for individuals who have difficulty leaving their homes.3
Reimbursement for outpatient services such as Medicare Part B, that are provided in homes as a result of patient preference or lack of transportation typically follow the guidelines set forth by the outpatient facilities and usually require a co-pay as patients are not homebound.4 Reimbursement for home health services varies and can be based upon prognosis, the patient's living situation, or insurance. Although Medicare A covers home health, non-Medicare payers may limit or exclude physical therapy as a covered home health service, resulting in the patient paying privately for therapy in the home, or being forced to obtain outpatient services. In all cases, PTs and PTAs should continue to document using principles consistent with APTA Guidelines: Physical Therapy Documentation of Patient/Client Management [BOD G03-05-16-41].5 Since documentation regarding pediatrics is covered in another chapter, this chapter will focus primarily on documentation for the geriatric client receiving services covered by Medicare A and provided by home health agencies (HHA), as most payers follow Medicare guidelines.
In 2008, Medicare reported a record number of home health participants: over 37.5 million aged 65+, and over 7.7 million disabled.6 Over the past decade, home care documentation by therapists and assistants has undergone a massive transition that includes revisions to the primary tool used to assess patients, and a push toward 100% electronic records.7,8 Clinicians must be familiar with specific regulatory requirements from national, regional, and state levels, and be aware of medication management, depression screening, case management, and diagnosis coding. Documentation for each treatment is highly scrutinized for skill level and medical necessity, and may ...