Failure to Provide Timely Rehabilitation Services Due to Insurance Verification Delays
Penalty
Summary
A resident admitted with diagnoses including type II diabetes mellitus, bipolar disorder, and depression was identified as needing physical, occupational, and speech therapy upon admission. The resident's comprehensive assessment showed intact cognition, limited range of motion in both lower extremities, and dependence on staff for transfers and toileting. Physician orders and therapy evaluations recommended therapy services to address mobility and strength. Despite these recommendations, the resident did not receive the prescribed therapy services in a timely manner. The delay in providing therapy was due to the facility's inability to confirm the resident's insurance information, which prevented the initiation of rehabilitation services. Staff interviews confirmed that therapy was not started because the facility could not verify the resident's payor source and did not have the necessary insurance documentation. As a result, the resident did not receive therapy as recommended until the facility resolved the billing issue, despite the resident expressing a desire to participate in therapy and improve mobility.