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A Review of the Policies and Procedures for Outpatient and Inpatient Rehabilitation Services.

DUBLIN, Ireland -- Research and Markets ( has announced the addition of Aging Physical/Occupational Therapy and Rehabilitation Care - 4th Edition, 2006 to their offering.

A 504 page compendium of detailed review criteria policies and guidelines for outpatient Occupational, Physical and Speech Therapy + inpatient rehabilitation services. The number of visits commonly required to treat specific conditions are listed as well as review criteria guidelines for rehabilitation care admission, continued stay and discharge for common disorders. Example protocols and other tools to improve care are located throughout the manual. References. Web sites. Resources include the Oregon pediatric rehabilitation guidelines and example home exercise handouts to give to patients.

Sample Content

--Introduction to rehabilitation services; Therapy referrals; Utilization management; Medical Necessity Criteria; Physical Medicine and Rehabilitation - Medicare LMRP; Physical Therapy/Occupational Therapy provided by physicians and physician employees Policy; 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 Procedure; Therapeutic exercises to develop strength and endurance, range of motion and flexibility; Physical Therapy - Defined; Automobile Driving Therapy; Level of care for therapy;

--Visit authorization Review Guidelines by Skeletal Structure:

Spine: Lumbosacral spine; low back pain, acute and chronic; Disability Periods for Lumbar Disc Disease - by type of treatment; Traction for low back pain; Back School Program, Manipulation of the spine under anesthesia; Lumbar spine, pre-surgical or non-surgical, Lumbar spine, post-surgical, Magnet Therapy for low back pain, Cervical spine, pre-surgical or non-surgical, TENS + therapy for chronic cervical pain; Cervical spine, post-surgical, Neck Pain,

Shoulder: pre-surgical or non-surgical, post-surgical, Total Shoulder - post-operative protocol, Rotator Cuff Repair/Impingement syndrome, Adhesive capsulitis, Ultrasound therapy for calcific tendinitis, shoulder, Elbow: pre-surgical or non-surgical, post-surgical, Lateral and medial epicondylitis, Wrist: pre-surgical or non-surgical, post-surgical, Carpal tunnel syndrome therapy; Hand/fingers: pre-surgical or non-surgical, post-surgical, Tenosynovitis/Flexor tendinitis involving the hand/fingers, Post Dupuytren's Release OT,

--Other conditions: Cerebral Palsy; Foot drop; Hypermobility, Polymyalgia, Multiple Sclerosis; R. A.; Osteoporosis; Reflex Sympathetic Dystrophy (RSD); 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; Temporomandibular Joint (TMJ) Disorders; Chronic Fatigue Syndrome (CFS); Visual Loss - Medicare Coverage of Rehab Services; Osteoarthritis; Parkinson's Disease; Normal Range of Motion, Hippotherapy/Therapeutic Horseback Riding/Equestrian Therapy.

--Speech and language therapy guidelines - Skilled Speech Services; Unskilled Speech Services; Aphasia; Vestibular Rehabilitation; Melodic Intonation Therapy for Persistent Aphasia; Speech-Language Initial Visits for Specific Abnormalities; Discontinuation of Speech-Language Benefits; Stuttering; Lidcombe program for stuttering; Dysphagia: Oral-Motor Therapy; CMS Edits for Speech-Language Pathology; Speech-Language Pathology Terms, Acronyms; References and resources for Speech-Language Therapy

--Acute Inpatient Rehabilitation Services: Review criteria for admission to a rehabilitation hospital, CORF medical review policy; Inpatient assessment of potential for rehabilitation; 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; Constraint-induced movement therapy (CIMT)

--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

--Quality Improvement Plan - Indicators, Quality 'flags', Benchmarks,

--Chiropractic services; 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

--Durable Medical 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; 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; Shoe inserts to relieve back pain in patients with leg length discrepancies; Wound Care Resources; 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; 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.

--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

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Date:Jan 4, 2006
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