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Below is a list of some of the upcoming Occupational Therapy Association conferences for each state in the United States.  Attending your respective annual conference is a great opportunity to earn continuing education credits and to network!

Alabama OT Association September 5-7 Orange Beach, AL (www.alota.org) 

Alaska OT Association September 5-7 Anchorage, AK (www.akota.org)

New Mexico OT Association September 12-13 Albuquerque, NM (www.nmota.org)

New York OT Association September 18-20 Syracuse, NY (www.nysota.org)

Maine OT Association September 19 Portland, ME (www.meota.org)

Arizona OT Association September 19-20 Phoenix, AZ (www.arizota.org)

Kentucky OT Association September 19-20 Paducah, KY (www.kotaweb.org)

Nebraska OT Association September 19-20 Omaha, NE (www.notaonline.org)

Nevada OT Association: September 19-20 Las Vegas, NV (www.nvota.org)

North Carolina OT Association September 19-21 Concord, NC (www.ncota.org)

New Jersey OT Association September 21 Eatontown, NJ (www.njota.org)

Massachusetts OT Association September 26 Westford, MA (www.maot.org)

Wyoming OT Association September 26-27 Cheyenne, WY (www.wyota.org)

Virginia OT Association September 26-28 Portsmouth, VA (www.vaota.org)

South Dakota OT Association September 27-28 Vermillion, SD (www.sdota.org)

Colorado OT Association October 3-4 Denver, CO (www.otacco.org)

Minnesota OT Association October 3-4 St. Cloud, MN (www.motafunctionalistfirst.org)

Oklahoma OT Association October 3-4 Oklahoma City, OK (www.okota.org)

Pennsylvania OT Association October 3-4 King of Prussia, PA (www.paota.org)

Washington OT Association October 3-4 Seattle, WA (www.wota.org)

South Carolina OT Association October 4 Columbia, SC (www.scota.net)

New Hampshire OT Association October 10 Concord, NH (www.nhota.org)

Ohio OT Association October 10-11 Perrysburg, OH (www.oota.org)

California OT Association October 10-12 Ontario, CA (www.otaconline.org)

Iowa OT Association October 11 Des Moines, IA (www.iowaot.org)

Idaho OT Association October 17-18 Boise, ID (id-ota.com)

West Virginia OT Association October 17-18 Morgantown, WV (www.wvota.org)

Michigan OT Association October 20-21 Mackinac Island, MI (www.mi-ota.com)

Tennessee OT Association October 24 Dickson, TN (www.tnota.org)

Georgia OT Association October 24-25 Atlanta, GA (www.gaota.com)

Missouri OT Association October 24-25 Maryville University (www.motamo.net)

Oregon OT Association October 24-26 Salem, OR (www.otao.com)

Hawaii OT Association October 25 Honolulu, HI (www.otah-hawaii.com)

Maryland OT Association November 7-8 Timonium, MD (www.mdota.org)

Illinois OT Association: November 13-15 Springfield, IL (www.ilota.org)

Texas OT Association November 21-23 Austin, TX (www.tota.org)

2009

Florida OT Association February 7-8 Orlando, FL (www.flota.org)

Connecticut OT Association March 28, 2009 North Haven, CT (www.connota.org)

Rhode Island OT Association May 2, 2009 CCRI Newport Campus (www.riota.org)

If you are studying for the NBCOT exam, please become a free member of the study groups for OTA students and OT students.  OT-ADVANTAGE.COM members, click on 'search profiles' and you will see the groups listed on the right side.  If you are not a member, you can become a FREE member today by clicking on 'Become a Member.'

Today, OT-ADVANTAGE.COM added a case study and matching questions for those studying.  Take a look and quiz your knowledge.  Please feel free to comment below and add how we can help you better prepare.

If you are an Occupational Therapy practitioner or even a Level II student at a skilled nursing facility, you have probably found it difficult to strike a balance between giving quality treatments in accordance with meeting a Medicare RUG (Resource Utilization Group) level.  Typically, when a patient is admitted to a skilled nursing facility from a hospital, and has Medicare coverage, the MDS coordinator sets reference periods.  If you are new to this area of practice, the reference periods are critical when establishing how many treatment minutes a client can/will receive for Physical, Occupational, and Speech therapy. 

To give you a crash course with reference periods, there are different levels a patient can reach, dependent upon their therapy treatment minutes, nursing intervention (i.e., IV antibiotics), and the period of time the patient will be receiving these.  Furthermore, the assessment period becomes Medicare's crystal ball.  They have preset reimbursement rates, given the set criteria.  For example, if the patient is receiving 150 minutes of therapy a day during a reference period, Medicare will reimburse accordingly.  If a patient is receiving 30 minutes of therapy combined (OT/PT/SLP) and IV antibiotics, Medicare will reimburse according to the designated RUG level as well.  Generally speaking, the more therapy treatment time the greater the reimbursement.

What becomes even more tricky is coordinating a patient's medical status (e.g., patient is nauseated and cannot participate with therapy on the day of admit), the amount of time Occupational/Physical/Speech Therapy has to evaluate and treat the patient upon admission (evaluation minutes do not count), nursing assessment (e.g., wound care or IV antibiotics), and how all of this can be combined to determine a patient's RUG level.  Usually, the MDS Coordinator and Rehabilitation Coordinator work together when setting assessment dates and the treating therapists assist in carrying out the plan. 

Now that you have a small background on what happens when a patient is admitted to a skilled nursing facility, it is time to tap into a frustrating area for Occupational Therapy practitioners.  Many times OT clinicians feel the pressure to see patients for 75 minutes of therapy a day, from their rehabilitation managers.  Rightfully, the patient's Medicare coverage is paying your facility based on the reference period RUG level for the patient's stay.  This is the key reason you cannot see a patient for 75 minutes a day during a reference period and then immediately taper them down to 30 minute treatment sessions a day.  This is a fraudulent act.  The reason being, the crystal ball that I previously mentioned, Medicare wants assessment periods set to pay for future dates of therapy.  If a patient was seen for 30 minutes a day by Occupational and Physical Therapy combined during a reference period, Medicare will pay that designated RUG amount for X amount of future days.

Many patients admitted to a skilled nursing facility from a hospital setting, were likely receiving inpatient rehabilitation (3 hours of therapy a day).  Therefore, their expectations may be to receive a few hours of therapy a day.  As an Occupational Therapist evaluating a new client, it is your responsibility to determine how much therapy this client can benefit from.  It becomes overwhelming thinking you should see a patient for 50 or 75 minutes a day, as well as see your regular caseload of Occupational Therapy clients.  So, how do you maximize your time with a client and help them reach quantitative results?  Here are some tips:

• Start Early: Begin seeing patients at 7am to address ADLs.  You may not be able to do the entire ADL, but you can initiate a portion each day (communicate with the nursing aid if you cannot complete a patient's ADL).  Seeing 2-3 patients for an ADL each day, rotating the patients you see to address everyone, you will soon see carryover of treatment.  This will also help eliminate the stress of seeing a patient for 50-75 minutes straight, who may not be able to tolerate that much time at once. 
• Group Patients:  Usually, a patient receiving Occupational Therapy can receive group treatment up to 25% of their regular treatment time for the week.  Have set daily groups that your patients can benefit from.  For example, set an adaptive equipment group up for 30 minutes on Tuesdays and address "How to Use Adaptive Equipment."  Or have a weekly exercise group, home safety, homemaking, or community re-integration group.  This will help utilize your time with a client for Occupational Therapy treatments, as well as aid a client in reaching a functional outcome.
• Dovetail:  This is a term many Occupational Therapy Clinicians should become familiar with.  Dovetail means you can see two Medicare Part A patients at the same time, but not charge them for a group treatment.  Keep in mind, if you are having the clients do the same activity it is a group treatment.  But if you are seeing 2 patients with different start/stop times this is considered a dovetail.  For example, say you are treating John from 9am-9:50am and Jane from 9:30am-10:20am.  Both are Medicare Part A clients receiving different types of treatment (e.g., e-stimulation, exercise...) and can be billed separately.  This helps Occupational Therapy practitioners utilize their time more effectively, while still addressing goal-oriented tasks.
• Education: Much of our time as Occupational Therapy clinicians is spent communicating with family, staff, other clinicians, and the patient about the therapy plan of care or how to use equipment appropriately.  If the patient is present, you can bill for this time.  For example, educating restorative staff or family/patient on a splint wear/care schedule is billable time.  Try to take advantage of this, as it will strengthen your documentation and justification for services, as well as improve the client's quality of care.

Keep in mind, all of the above tips and suggestions should be referenced in accordance with your facility's regulatory standards.  Please consult with you rehabilitation manager or your policy and procedure manual to accurately determine how to best utilize your time with your client, in accordance with Medicare Part A guidelines. 

Hi OT-ADVANTAGE.COM members,

Since the NBCOT exam is a hot topic on this website, a study group was developed.  Please go to 'search profiles' (http://ot-advantage.com/ota/searchprofiles.aspx).  You will see 2 groups, one for the OTR exam and for the OTA exam.  Feel free to add information on study tips, good study materials, blog, add documents, and more.  Consider this your group.  Comment below if you have other ideas on how OT-ADVANTAGE.COM can help prepare you for the BIG exam!

As many Occupational Therapy clinicians worried about their patients needing to pay for costly therapy services, as well as tracking OT charges, the weight has been lifted.  On July 15, 2008, the U.S. House of Representatives and Senate voted to override and pass HR 6331.  Therefore, Occupational Therapy services through December 31, 2009, fall under the 18 month extension of the therapy cap exceptions process. 

For more information on Medicare and Medicaid coverage and the therapy exceptions process, please visit:

www.cms.hhs.gov

Here is more helpful information that may help you with your communication with Occupational Therapy clients, as well as for Occupational Therapy practitioners.

Follow this link to provide a handout for your Occupational Therapy clients: http://www.medicare.gov/Publications/Pubs/pdf/10988.pdf

If you are still trying to make sense of the Medicare Physician Fee ScheduleUpdate for 2008, and how it applies to Occupational Therapy, read below for helpful information.

• The recent 10.6% reduction goes into effect July 1, 2008.  Occupational Therapy clients who received services, and were provided services under the exceptions process, will have that amount counting toward their annual limit ($1810 for Occupational Therapy).  However, CMS does not plan to collect any amount provided from 1/1/2008-6/30-2008 for amounts falling under the exceptions rule.
• Services provided on or after 7/1/2008 will be held by CMS for 10 business days.  After 7/15/2008, if Congress does not pass the necessary legislation, CMS will process the claims.  If Congress passes legislation after 7/15/2008, and CMS has already processed the submitted claims, it may be necessary to resubmit claims.
• No longer use the KX modifier for Occupational Therapy clients who require therapy past their annual limit.
• Occupational Therapists and Occupational Therapy Assistants are in a dilemma.  Some possibilities to work around the current situation may be to educate the client on paying out of pocket, decrease the frequency of treatment or treatment time or delay treatment, or have the client seek care in an outpatient department (e.g., hospital) where the mentioned therapy cap does not apply.  CMS is offering competitive billing through select vendors for certain DME equipment (e.g., wheelchairs, prosthetics), that may benefit the client in the meantime.  Your current employer may be willing to pay for the costs that exceed clients annual limit, until Congress passes the needed legislation.  Please communicate with your rehab manager to find the options available regarding this matter.
• How can you help?  AOTA has a letter on their website that you can complete and submit via their site to the U.S. Congress.  Go to: http://capwiz.com/aota/issues/alert/?alertid=11547586

The above information was obtained from: http://www.cms.hhs.gov/.  Please visit this site for additional information.

As Occupational Therapy practitioners you need to stay informed of changes to Medicare.  Staying abreast of the changes will allow you to better communicate with your client.  As of 6/30/2008, CMS (Centers for Medicare and Medicaid Services) denied a delay on the therapy cap exceptions process.

Please visit: http://www.cms.hhs.gov/physicianfeesched/downloads/cms-1385-FC.pdf for detailed information regarding the therapy cap. 

What does this mean? 

• Your client, if they are at their Medicare cap (Occupational Therapy cap is $1810), may be responsible for paying for services after 6/30/2008. 
• If you have a student, determine if the application of the Medicare Part B policies to Part A settings will effect their supervised treatments.
• If in a hospital or SNF, a plan may need to be established prior to initiation of treatment.  This is specific to the payment policy and CMS will provide further info.
• Originally a re-certification for treatment needed to be certified by a physician each 30 days.  It has now been extended to 90 days.

What should you do in the meantime?  Speak with your rehab manager about action you should take to inform your client of the possibility they may pay out of pocket for Outpatient Occupational Therapy treatments.  You may need to issue your client a form and have them sign it, in order to have documentation that the client is aware of their insurance benefits. 

Please review the applicable sections of the Medicare Physician Fee Schedule Rule Update for 2008, to obtain additional information: http://www.cms.hhs.gov/physicianfeesched/downloads/cms-1385-FC.pdf

When OT-ADVANTAGE.COM launched on April 10, 2008, the first 500 Occupational Therapy students (OT or OTA) to sign up were automatically entered into the NBCOT exam fee drawing.  One problem with this drawing, when people became a member, they forgot to edit their profile and list whether they were a student or practitioner!  OT-ADVANTAGE.COM sent out reminders via email newsletters for members to edit their profiles.

Recently, the drawing was complete.  However, the winner did not respond.  Many may be delighted to hear there will be another drawing.  This is your last chance to avoid paying up to $500 for your NBCOT exam.  One winner will be chosen from the original first 500 students who became a member.  The only way for OT-ADVANTAGE.COM to know if you are a student is if you specify on your profile. 

*Remember*

One of the great perks of this website is the social networking component.  The more you add about yourself on your profile, the easier it is to network and become a resource to others, as well as to reconnect with past classmates and colleagues. 

As always, thanks for being a member of a great Occupational Therapy community.

Historically, Colorado regulated Occupational Therapy clinicians through Title Protection and the Deceptive Trade Act.  Please follow the link below to find out about Colorado's new law to now register Occupational Therapists and Occupational Therapy Assistants:

http://www.otacco.org/documents/Final%20Bill%20152%20Passed.pdf

http://www.otacco.org/content.php?page=Regulation%20of%20Occupational%20Therapy

If you are an OT clinician being asked to incorporate more groups or an OT student planning a group for a class presentation or for a fieldwork assignment, a question mark may be floating in your mind!  It becomes difficult to create a group that can have influence on each client.  One client may require direct 1:1 attention, another is quite high level and needs more challenge, and someone else may be the hater (never wants anything to do with therapy, but can really benefit). 

So, how do you strike that balance?  I have been an OT for 5 years and struggle with this at times.  If you're stuck, don't worry.  It means you're normal!

I'll give you some ideas that may work for you that I have used in the past. 

Pediatrics:

Edible Playdough Group

Kids love to eat or just bite on things they play with.  This is great if you have a client with latex precautions too.

• Pincer grasp: Have your clients roll their dough into a snake and then pinch sections of it.
• Coordination: Rolling the dough in the hands or pulling small pieces off of a roll.
• Bilateral Integration
• Proprioception: If the client can stand or sit at a higher surface than the table, they can knead or press into the dough.
•  Play: Need to see how a client interacts with other children and stimuli?  This may help you out with your assessment.
• Sensory Integration: If your client has difficulty with different textures this may be a way to grade your interventions (progress up/down).  Maybe add other edible treats in there, like skittles, for them to pick out. 
• Postural Stability: Have the client sit on a theraball while manipulating dough.

Follow this link for recipes on making and storing various types of edible pladough: http://www.familycorner.com/family/kids/crafts/edible_play_dough.shtml

Adolescents:

Outdoor Sport Activity

Clients in this age range may present with more behavioral diagnoses.  Providing an atmosphere for them to expend their energy, interact with others, while also succeeding is great.  Finding a sport that can provide this may be difficult.  Here are some ideas.

• Softball: This is a sport that offers many positions for your client to feel they are contributing to the group, and offers them a chance to be successful given their strengths.  One way to downgrade this group is to play catch and then progress to a larger group for a softball game.
• Golf: While this is a more tame sport, it requires great attention and thought-process.
• Volleyball: Sometimes this game allows for some wiggle room if you do not have enough players.  A way to downgrade this if you don't want to use a volleyball is a balloon.
• Relay races

*Remember you do not need to follow the game rules100%.  Participation is key and games can be adapted.

Adults/Older Adults:

The choices in this area become vast, as you are addressing a myriad of diagnoses.  Below are a few suggestions.

• Home Safety:  Show pictures of an unsafe environment and have the group discuss how the home can be modified.  Present adaptive equipment and provide information on costs and/or insurance reimbursement.  Try to make this interactive to gain and keep everyone's attention.  Have handouts with medical supply stores, companies that provide home modifications, and invite family.
• Cooking/Homemaking: This poses problems in several facilities because many do not have a stove, oven, or sink.  Sometimes you really need to tug on your creativity strings.  One idea is try making a fruit bouquet.  Buy some skewers and fruit.  Use cookie cutters to be creative with making shapes for the fruit and stick them on the skewers.  You can take it further and have a styrofoam block to stick the fruit skewers in to make a bouquet.  A higher level client can help with the item transport.
• Exercise: Exercise is important while trying to increase a client's activity tolerance, coordination, ROM, and more.  If possible, incorporate the exercises into a group that you may be giving to the client upon their discharge.  This may help them make it part of their daily routine.  This would also be a good time for education: issue theraband or educate them on what they can use at home for weights (i.e., canned food, bag of beans), tell them why exercising their arms and/or legs is important, and educate them on how to breathe when exercising.  Any precautions a client may have should also be addressed (i.e., cardiac).
• Leisure: This can be fun!  Choose something many can benefit from like bowling, balloon volleyball, air hockey (improvise on this; instead of a puck use a large checker), jenga, or hangman.
• PNF: Grading this task can be done creatively.  Think of the PNF diagonals as your core and expand upon it by incorporating balls, sitting on a theraball, reaching in the kitchen, or gardening. 

Use your clinical judgment when addressing groups.  The best part of being an OT clinician or student is the use of your creativity.  The way you document and expand on how your group addresses your client's functional performance areas will make you exceptional. 

Also, do not feel pressured to incorporate groups due to productivity requirements, to manage a large caseload, or because of a client's payor source.  While these are important, remember to do what is best for the client. 

Please comment below if you have feeback or can offer more group ideas.