Failure to Screen and Pursue Authorization for Therapy Services
Penalty
Summary
The facility failed to ensure that residents were properly screened for therapy services and that therapy staff pursued authorization to provide those services. For one resident with dependence on renal hemodialysis and tracheostomy status, care conference documentation indicated requests for rehabilitation services to improve strength and ambulation. However, the Director of Rehabilitation (DOR) was unaware of the resident's wheelchair and could not provide evidence of therapy screenings or follow-up on insurance authorization denials. The resident was evaluated by physical and occupational therapy but discharged from both without receiving treatment due to lack of insurance authorization, and there was no documentation of follow-up with the insurance company or evidence of quarterly therapy screenings after the initial evaluations. Another resident with diagnoses including gout, COPD, and right foot drop was also not properly screened for therapy services. Although this resident was evaluated by physical therapy and recommended for services, no treatment was provided due to lack of insurance approval, and there was no evidence of follow-up with the insurance company. Additionally, there was no documentation of quarterly therapy screenings by occupational or physical therapy for this resident. The facility's policy stated that therapy screens should be completed quarterly, but this was not consistently done, and staff could not provide evidence of required notifications or follow-up actions.