Podcasts about jimmo

Who wants to talk about a fun topic?! What if learning about Medicare Maintenance Therapy actually was fun and didn't make you fall asleep? Well, that's what you're going to get on today's episode! We sat down with our favorite Medicare Utilization Reviewer, Dr. Robbie Leonard, PT, DPT, CHC to discuss the hot and sticky points about Medicare skilled therapy. We know a LOT of US-based therapists have questions and we're here to help! In today's show we discuss some common misconceptions about using Medicare for therapy so we can help you pass an audit and stay out of trouble!  Some of the topics covered today include: Medicare's definition of medical necessity and when it does and does not cover services The only 2 standards under which you can treat - restorative and maintenance and what they each mean When do to restorative and when to do maintenance and why you should NOT mix the two The questions you should ask yourself every time you see a patient: Could what I'm doing be provided by a caregiver or technical person that I train? If yes, it should not be billed at all. Unfortunately it doesn't matter whether there is a qualified caregiver available or not. How you get audited: You can be flagged to be audited because your data profile looks different. If you always use or never use KX you can be audited for being an outlier. You should never stop seeing people just because they've reached the threshold. This can be a red flag! What you should NEVER say to a patient about their Medicare dollar usage When it is and is not appropriate to stop providing skilled therapy (hint: it doesn't have to do with where the patient is in their threshold spend!) How to know if you can provide more therapy to a person who's reached their threshold for the year: evaluations will always be covered!  Why you should not be concerned (or turn away) a patient who has used up to their Medicare threshold or beyond Initial threshold What about Medicare and cash? If you're providing a covered service you cannot opt out of Medicare as a therapist. You are legally obligated to file a claim. What does wellness look like then? What does a reasonable time frame actually look like? Jimmo settlement CMS Medicare regulations all US therapists should read: Medicare Benefit Policy Manual Chapter 15, Section 220.2 D NeuroSpark members find the Parkinson Focus Track call recording with Robbie HERE with additional information covered Find Robbie at: robbie@8150advisors.com **Please note, the contents in this episode are for educational purposes and should not be considered legal advice

Trifulca Media presenta: La Pandemia Urbana X-Traaa con, Geraldo, Omar y Jimmo quienes analizan el reciente tema musical de Rene Perez. Sigan a Trifulca Media en: Facebook: https://www.facebook.com/TrifulcaMedia?mibextid=LQQJ4d Instagram https://instagram.com/u latrifulcawrestlingmedia?igshid=dhkuulk3mb5x Twitter https://mobile.twitter.com/TrifulcaMedia YouTube https://youtube.com/channel/UCVZ0 #residente #ronenelpiso #lapandemiaurbana #lapandemiaurbanaxtraaa #xtraaa #charlandodecineytv #trifulcamedia #enlaclaraconlatrifulca #trifulcawrestlingpodcast --- Support this podcast: https://podcasters.spotify.com/pod/show/trifulcamedia/support

Trifulca Media presenta: La Pandemia Urbana X-Traaa, con Alex, Geraldo y Omar quienes se unen a Jimmo para hablar de lo más reciente en el genero urbano. Sigan a Trifulca Media en: Facebook: https://www.facebook.com/TrifulcaMedia?mibextid=LQQJ4d Instagram Jt https://instagram.com/u latrifulcawrestlingmedia?igshid=dhkuulk3mb5x Twitter https://mobile.twitter.com/TrifulcaMedia YouTube https://youtube.com/channel/UCVZ0 #lapandemiaurbana #lapandemiaurbanaxtraaa #reggaeton #farruko #anuel #6ix9ne #trifulcamedia #enlaclaraconlatrifulca #trifulcawrestlingpodcast --- Support this podcast: https://podcasters.spotify.com/pod/show/trifulcamedia/support

Trifulca Media presenta: La Pandemia Urbana X-Traaa con Alex, Omar y Jimmo quienes hablan de todo lo que a ocurrido entre la Guerra de Anuel AA y Arcangel La Maravilla. Sigan a Trifulca Media en: Facebook: https://www.facebook.com/TrifulcaMedia?mibextid=LQQJ4d Instagram https://instagram.com/u latrifulcawrestlingmedia?igshid=dhkuulk3mb5x Twitter https://mobile.twitter.com/TrifulcaMedia YouTube https://youtube.com/channel/UCVZ0 #narcan #arcangeleschota #chota #arcangel #anuelaa #tempo #cosculluela #reggaeton #tiraera #xtraaa #lapandemiaurbanaxtraaa #lapandemiaurbana #trifulcamedia #enlaclaraconlatrifulca #trifulcawrestlingpodcast --- Support this podcast: https://podcasters.spotify.com/pod/show/trifulcamedia/support

Trifulca Media presenta: El primer episodio de La Pandemia Urbana X-Traaa en el cual Omar y Jimmo hablan sobre un guerra que podría detonarse en cualquier momento entre Cosculluela y Bad Bunny. Además la de Ñengo Flow y Luar La L. Además hablan de la tóxica pareja más viral del género. Sigan a Trifulca Media en: Facebook: https://www.facebook.com/TrifulcaMedia?mibextid=LQQJ4d Instagram https://instagram.com/u latrifulcawrestlingmedia?igshid=dhkuulk3mb5x Twitter https://mobile.twitter.com/TrifulcaMedia YouTube https://youtube.com/channel/UCVZ0 #badbunny #cosculluela #6ix9ne #tekashi #yailynlamasviral #reggaeton #tiraera #xtraaa #lapandemiaurbanaxtraaa #lapandemiaurbana #trifulcamedia #enlaclaraconlatrifulca #trifulcawrestlingpodcast --- Support this podcast: https://podcasters.spotify.com/pod/show/trifulcamedia/support

Welcome to the Balanced FI Podcast, episode 24! Thank you so much for listening in! Appealing health insurance denials is the best (maybe only?) way to increase the chances your health insurance provider will cover the requested medical treatment. So many times a claim is denied automatically, or without sufficient investigation, so it falls to the patient (or patient's representative) to appeal the denial and seek coverage. To appeal a health insurance denial, you need to:Request coverageReceive the denialCall insuranceGet more informationContact your providerFollow the appeal processAsk what the next step isRESOURCES:Read: The Ultimate Guide to Appealing Health Insurance DenialsRead: Meet RaLeaFax ZeroPatient Advocate Foundation SOURCES:HeathCare.gov: Appealing a health plan decision - External ReviewCenter for Medicare Advocacy: Frequently Asked Questions (FAQs) Regarding the Jimmo v. Sebelius “Improvement Standard” Settlement

Medicare 101 presents expert information about Medicare benefits and navigating the system from Judith Stein and Kathleen Holt from Center for Medicare Advocacy. The discussion centers around your legal rights and how best to access them when entering a skilled nursing facility, what type of Medicare plans are available and which is best for you, and how advocacy is there for everyone. Judith Stein is the Executive Director of the Center for Medicare Advocacy, which she founded in 1986. She has focused on legal representation of older people since beginning her legal career in 1975. From 1977 until 1986, Ms. Stein was the Co-Director of Legal Assistance to Medicare Patients (LAMP) where she managed the first Medicare advocacy program in the country. She has extensive experience in developing and administering Medicare and related advocacy projects and conferences, representing Medicare beneficiaries, producing educational materials, teaching and consulting. She has been lead or co-counsel in numerous federal class action and individual cases challenging improper Medicare policies and denials – including, Jimmo vs. Sebelius, which is opening doors to Medicare coverage and access to care for people with longer-term and chronic conditions. Kathleen Holt joined The Center for Medicare Advocacy in 2014 as Associate Director. Ms. Holt began her career with CIGNA Insurance Company, developing insurance claim process improvement strategies. After obtaining her M.B.A. in Healthcare Management from the University of Connecticut, Ms. Holt helped protect patient rights and expand patient services as a hospital administrator – first at New Britain Memorial Hospital in Connecticut, and then at Northwest Hospital in Seattle, Washington. After obtaining her law degree from Seattle University in 1993, Ms. Holt became a Special Assistant United States Attorney for the U.S. Department of Health and Human Services in Seattle. In that position, Ms. Holt authored health law opinions, litigated in federal court, and served as in-house attorney for administrative law judges. In 1997, following the birth of her profoundly disabled second child, Ms. Holt founded a Seattle area law practice to advocate for the needs of older and disabled people. She led this practice until her arrival at the Center for Medicare Advocacy. Mairead Painter is the Long Term Care Ombudsman for the state of Connecticut and a leader who is building strong community ties in the challenging area of long term care. She brings her expertise to address issues and solutions to Your Care-Your Rights-Your Voice podcast. Join the conversation! Follow the podcast on the platform you are listening and leave a review if possible. Follow on Twitter: @maireadpainter Follow on Instagram: @maireadpainter Follow on Facebook: @YourCareYourRightsYourVoicePodcast Resources: https://portal.ct.gov/LTCOP?fbclid=IwAR0X2q0Lqaz-X7lvHu_uXNBMerLeGLpa7YFtk8mlIpQLD1BsccVjAYTYehs Nature by MaxKoMusic | https://maxkomusic.com/ Music promoted by https://www.chosic.com Creative Commons Attribution-ShareAlike 3.0 Unported https://creativecommons.org/licenses/by-sa/3.0/deed.en_US --- Send in a voice message: https://podcasters.spotify.com/pod/show/mairead-painter/message

From LONDON, ONTARIO. Jiu-jitsu black belt, judo brown belt, kids instructor, my old training partner and the toughest steamroller from turtle in the game…Craig Ferguson joins the show! Great convo about best ways to teach beginners, BJJ while travelling, funny Royce Gracie stories and more.

In this episode, Co-Owners of Kornetti & Krafft Health Care Solutions, Dee Kornetti and Cindy Krafft, talk about all things maintenance therapy and care. Today, they talk about maintenance therapy in the home, diversifying revenue, and they bust a few maintenance therapy myths. How can maintenance patients have a goal statement if they're never going to get better? Hear about home-based therapy, teaching patients to self-manage, Medicare part B, and their book The Guide to Delivery of Home-Based Maintenance Therapy, all on today's episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “It's never been that if you don't improve, then services aren't covered.” “Rehab potential is the responsiveness to care.” “The myth of coverage has some roots in the denial issue.” “If there's room for improvement, a restorative or improvement course of care is what your skills would be indispensable for. That's what would make your care medically necessary under the Medicare benefit.” “If someone else can do it just as well as I can then this is no longer considered skill.” “We are helping patients be accountable for their chronic disease management.” “There are times that we are indispensable to help people improve and recover function back to a prior level or maybe beyond, and then there's times we are needed to preserve and stabilise their exiting function so that their quality of life can continue on in the fashion that it currently is.” “Be a bit more open-minded with how physical therapy really works in reality. Don't assume that what your path at the moment is THE path and can't vary and can't change. There are many other ways you can utilise your skill to benefit those around you.” “Don't be afraid to ask questions, and don't think you have to know it all.” “If you've got a great idea, or you have something that is a passion, and you've got that intersection of your passion and your skill set, go for it. Start to explore that. The possibilities are endless.”   More about Dee Kornetti Dee, a physical therapist for 35 years, is a past administrator and co-owner of a Medicare-certified home health agency. Dee now provides training and education to home health industry providers as Owner/Founder of a consulting business, Kornetti & Krafft Health Care Solutions, with her business partners Cindy Krafft and Sherry Teague. Dee is nationally recognized as a speaker in the areas of home care, standardized tests and measures in the field of physical therapy, therapy training and staff development, including OASIS, coding, and documentation, in the home health arena. Dee is the current President of the American Physical Therapy Association's Home Health Section and serves on the APTA's national Post-Acute Work Group. She serves as the President of the Association of Homecare Coding and Compliance, and a member of the Association of Home Care Coders Advisory Board and Panel of Experts.  She has served as a content expert for standard setting for Decision Health's Board of Medical Specialty Coding (BSMC) home care coding (HCS-D) and OASIS (HCS-O) credentialed exams. She holds current credentials in Home Health Coding (HCS-D) and Compliance (HCS-C) from this trade association.  Dee is also on Medbridge's Advisory Board for development of educational content on its  home health platform, and has authored several courses related to OASIS, Conditions of Participation (CoPs) and therapy. Dee is a published researcher. on the Berg Balance Scale, and has co-authored APTA's Home Health Section resources related to OASIS, goal writing and defensible documentation for the practicing therapist. Dee has contributed chapter updates to the Handbook of Home Health Care Administration 6th edition, and co-authored a book, The Post-Acute Care Guide to Maintenance Therapy published in 2015, along with an update in 2020 titled, The Guide to Delivery of Home-Based Maintenance Therapy that includes a companion electronic workbook. Dee received her B.S. in Physical Therapy from Boston University's Sargent College of Allied Health Professions, and her M.A. from Rider University in Lawrenceville, NJ. Her clinical focus has been in the area of gerontology and neurological disease rehabilitation.   More about Cindy Krafft Cindy Krafft PT, MS, HCS-O is an owner of Kornetti & Krafft Health Care Solutions based in Florida. She brings more than 25 years of home health expertise that ranges from direct patient care to operational / management issues as well as a passion for understanding regulations. For the past 15 years, Cindy has been a nationally recognized educator in the areas of documentation, regulation, therapy utilization and OASIS. She has and currently serves on multiple Technical Expert Panels with CMS Contractors working on clinical and payment reforms and bundled payment care initiatives. Cindy is an active member of the National Association of Home Care and Hospice (NAHC) and currently serves on multiple committees. She has written 3 books – The How-to Guide to Therapy Documentation, An Interdisciplinary Approach to Home Care and the Handbook to Home Health Therapy Documentation – and co-authored her fourth, The Post-Acute Care Guide to Maintenance Therapy with her business partner Diana Kornetti PT, MA, HCS-D.   Suggested Keywords Maintenance, Therapy, PT, Physiotherapy, Improvement, Assessment, Goals, Home Care, Rehabilitation, Accountability, Medicare, Myths, Health, Healthcare, Sustainability,   Book Discount Code (10% OFF): KK2021 The Guide to Delivery of Home-Based Maintenance Therapy   To learn more, follow Dee and Cindy at: Email:              kornetti@valuebeyondthevisit.com Website:          https://www.valuebeyondthevisit.com Facebook:       Kornetti Krafft HealthCare Solutions Twitter:            @Dkornetti                         @KornettiKrafft LinkedIn:         Kornetti Krafft HealthCare Solutions   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  Speaker 1 (00:01): Hi, D N Cindy. Welcome to the podcast. I'm happy to have you guys on. Welcome. Welcome. Thanks for having us happy to be here. Glad to be here. Excellent. So today we are going to be talking about maintenance therapy. So when a lot of physical therapists think about maintenance therapy, they often think that, well, this is something that's not reimbursed. This is something that maybe the patient doesn't quote unquote need. So today we're going to talk about what it is, some of the myths and a lot of other stuff surrounding maintenance care. So my first question is, can you define what maintenance care is or maintenance therapy? Speaker 2 (00:47): Okay. Karen, this is Cindy. I'll take that one. I think, you know, just as you were saying, the word maintenance, I'm sure at least one listener twitched, a little, the eye Twitch, the uncomfortable many times when you say the word maintenance, it looks like, you know, people react like you swore in church to like, oh, I don't do that. Or I, you know, somebody does that and get in trouble. And, and I think even the word has become a barrier. So Dee and I have tried to reframe the conversation by getting to the heart of what it is by referring to it as stabilization of function. So putting aside that baggage and the history of the word, the approach to care is saying I'm utilizing all the wonderful things I know as a therapist, my ability to assess and all of those great things and develop a care plan. But the end result that I'm going for is a stabilization or preservation of their functional level or slowing of decline. I think maintain can get people tied up in knots and miss the point or think that we have to do all kinds of different things, which we'll talk about in a moment with the myths. But I really think it helps to, to approach it as we're talking about stabilizing someone's function. Speaker 1 (01:58): That makes a lot more sense. And I really like that word. And you're right. I feel like maintenance care does kind of give people that, oh, I don't know if that's quite my lane, but when you say stabilization of function, preservation, decreased speed of decline. I think physical therapists are like, yeah, of course that's what we do. We'll think about it. We, we, we treat patients that have these chronic diseases right there. We don't share them. They go to doctors, numerous doctors, you know, cardiologists primary care, right. With their, with our heart conditions, they see nursing, right. They see all kinds of disciplines and all kinds of professionals. But they're never getting cured. They're it's management of their symptoms, right? So, so it's to like Cindy said, we are, we're going to preserve function. We're going to, you know, optimize their ability. Speaker 1 (02:50): We're gonna re hopefully use our skills, knowledge, and ability to reduce their demand or their requirement, higher cost centers of care. What happens when you have poorly managed symptoms of chronic disease, like COPD or CHF or diabetes, these people use urgent, emergent care. These people go in the hospital. This is extremely costly to our, to our medical system. And it's, it's not sustainable as an aging pie, you know, as we age as the population. And so this idea that there's things we can do to have people function optimally, no matter what phase or stage of this chronic condition they're in too, so that they're not as dependent or on higher cost centers of care, or they don't realize the kind of sequella, you know, think about a diabetic with poorly managed blood sugar, you know, that starts to develop retinopathy Neff, prophecy, peripheral neuropathy, right? All these other problems that happen. You know, that's all very manageable. If we can get an early and often and preserve an optimized, I even say optimize function. So we're not improving people necessarily because sometimes they haven't already experienced a decline. A lot of times we're just going in there to share what we know so that they can be accountable and manage these chronic diseases themselves. Yeah. That makes so much Speaker 2 (04:16): Karen. I would add to that, you know, for your listeners, cause some folks, you know, D and I have been talking about this for years. Some folks have a difficult time with this conversation, not just the word, but the concept. It sounds good. It sounds valuable. But I think we have to take a moment and acknowledge how deeply as therapists. We have defined ourselves by that word improvement. You can see it in our documentation. If you're going to get physical therapy, you're going to walk five feet more or 10 feet more, every time I get near you because that's, that's what I have to do. And that if I'm not improving you, we've all been told that if, you know, after a certain number of visits or certain number of treatments, if you don't see improvement, you're obligated to discharge people. When you start finding out that, that isn't really true and it hasn't really ever been true. Speaker 2 (05:06): I think we've got to give ourselves a little bit of grace here and realize that this can be quite the seismic shift internally about how we value ourselves as therapist, how we define ourselves and how we're defining ourselves to our patient populations. I think to the patients, to the potential patients, to our other members of the interdisciplinary team, we've done such a bang up job, talking about improvement, that when they don't feel that they're going to improve as, as the beneficiary or other members of the team say, well, that's patient, isn't going to get better. They don't even refer them to us. They don't even come to us because we've created this wall of you have to be able to get better, or you can't come to physical therapy. Speaker 1 (05:47): Yeah. Oh, I'm sorry. I was going to say, Cindy, what's your favorite line? When you talk about how we are addicted, like we, we are ingrained with improvement. What is your favorite line to say? Speaker 2 (05:57): Oh, well, I created a little, self-assessment like you answer these questions to get these points about how addicted are you. Because it, I feel very comfortable using that word because this challenge is a lot of those core beliefs. And we have identified ourselves by this. So tightly that it's like, okay, we, we have to step outside of our comfort zone a bit. And then as we see therapists start to do that, then we get the questions. Then we get the, okay. I kind of understand it, but what about this? And what about that? And what about this other thing? And that's when the myths all start to bubble up to the surface with where did that even come from? Speaker 1 (06:40): Yeah. So let's talk about some of those myths and see if we can bust them. So I will, I'll take, I'll throw it over to you guys. Either one of you can start, but let's talk about a couple of myths of maintenance therapy for me. One big one is, well, it's not covered. Speaker 3 (06:58): It's not covered by insurance. Speaker 1 (07:00): I'll take that one. This is thing. Yeah. Well you know, maintenance has been part of the Medicare benefit under any Medicare beneficiary part a or part B, since you can find it in the Medicare benefit policy manual, as far back as the, as the 1980s. So it's been around forever. This is not new, that Jimmo V Sebelius case that was brought forward. Just kinda shine the light on it, but it's never been that if you don't improve and services aren't covered or you don't have no, this idea that rehab potential is the ability to improve no rehab potential that we all typically document at some point is the responsiveness to care, right? That's what rehab potential is. Whether the care is going to allow you to improve from where you are at the baseline of assessment or to maintain or stabilize your function from where you are now without any unforeseen event in the next three, six, nine, 12 months, two years, are you going to be able to manage this condition and not decline, right? Speaker 1 (08:13): Or if you're in a progressive type of disease process, are you functioning optimally? And are we slowing that deterioration or decline? That is a normal part of the condition. So Cindy, I can pop a punch it over to you. And since we talk about it being paid, I think we busted that Karen. Right? We busted that pretty good. Okay. So, so other payers, I don't know, but anybody that is a Medicare provider, so under part a or part B, it, it is part of the benefit. Okay. So Cindy, talk to me about what are the type of conditions that are covered by maintenance as if the diagnosis determines it? What do we know about that? Speaker 2 (09:00): Well, very often what we hear is, okay, I understand maintenance therapy. I know what it's for. It's for people who have progressive neurological conditions. So it would make sense for Parkinson's. It makes sense for Ms. It makes sense for ALS. So it must be those three patient populations that are maintenance. Okay. We got to step back for a minute. There are patients with those three conditions that benefit and have the ability to improve with therapy. So it's not Parkinson's is synonymous with maintenance. And there's nothing in the coverage criteria that is diagnosis specific. Diagnosis is only one piece of the conversation. It is where are they functionally? What are the, what is the impact of this diagnosis and their resorted comorbidities on their functional ability? And what does a therapist know? What does that skill that you bring to the table that is unique to that discipline that is indispensable to this patient? Speaker 2 (09:56): But I think the myth of coverage has some roots in the denial issue. We, we can't go past this point without acknowledging that therapists have seen denials for providing maintenance therapy, that you did not show improvement in wham. They took away payment for part of this care, which is what drove the Jim versus civilians conversation that led to the court settlement with CMS to basically say, you know, Hey, we've looked at this benefit. It doesn't say you have to improve to get services. And, and we're, we're good friends with Judah Stein who was the lead attorney in that case, and still has the ability to call CMS back on the carpet and the legal sense about how that settlement has played out since, because CMS basically approached it with a oops, you're right. It doesn't say that shame on us, but it's like, wait a second. Speaker 2 (10:48): You've been denying coverage of services for a long time. And so it's very hard to say, yes, it's in there. And we understand it's in there. And D and I've explained the fundamental pieces of that, but there's still that I got denied, or I know somebody who got denied this can't possibly be true and it's unfortunate. And my personal opinion is I have a really hard time with CMS, just kind of Oop, seeing it versus, you know, ownership. And we saw a subsequent event to the initial Jimmo case that compelled CMS to put on their resources, particularly on their website, where they had to quote disavowal the improvement standard. So not just say oopsies, but say you have to flat out say that does not exist. And if beneficiaries qualify for these services, they absolutely should get them. Speaker 1 (11:36): Yeah. The, the, the woopsies sees that my bad defense never, ever seems to go over well, does it? No, no, no. Okay. So we talked about, is it covered? We talked about diagnoses covered. What other big myths are there surrounding maintenance therapy? All right. I Speaker 2 (11:59): Got one for you. D I got, you know, where I'm going. We very often hear they say, okay, so if it's not about their diagnosis, I need to assess the patient. Right. Figure this out. So now looking at what I typically do in an assessment, oh, test and measures. Well, those must not apply. Then I wouldn't be using tests and measures on a maintenance patient. And we would say, well, why not? Well, why would I measure something if I measure it again later? And it's the same, then why did I measure it to begin with? So any thoughts on those tests and measures in the maintenance patient D Speaker 1 (12:32): Yeah. Well, and, and I'm going to tie it to goal statements too, from there, right? So, so this idea, why do we take objective measurements of patients to establish a baseline, right? And we need to do that regard, you know, based on the presentation of the patient, regardless of their diagnoses and comorbidities, because we want to see if they're functioning at, or near where we would expect them think of a class three heart failure patient, are they functioning where you would expect, you know, a class three heart failure patient to function, or are they functioning like end stage, right. Class four, are they functioning below where you would expect them to function? And so obviously if there's room for improvement, a restorative or an improvement course of care is what your skills would be indispensable for. That's what would make your care medically necessary under the Medicare benefit part a part B that's what it would do so that the tests and measures, establish that baseline. Speaker 1 (13:30): And you compare, this is how the patient's functioning. This is how we'd expect them to function. Now, when you get a patient who is functioning at, or near where you would expect them to function with, with their PR their presentation, the question you have to ask yourself, as you don't just jump right to maintenance, right? You can't just say, okay, this a maintenance patient. They need me. Yeah. Basket. What do they need me for? You know, is there something I can teach them, train them, provide them so that they continue to stay, be stabilized, maintain, be accountable for their care over longer period of time. Right? And if the answer is yes, then you absolutely should pick them up on, on, on a maintenance course of care, because there's some sort of skills, your knowledge, your expertise, that which makes you, you, what I like to call the magic, that is me as a PT, right. Speaker 1 (14:21): And we've all had those magic. That is me moments. When you ever, whenever you walk or, or you, you readjust a, an assisted device to properly fit a patient and people look at you like, oh my gosh, why didn't we think of that? And it's just like, because you're not the magic. That is me. I mean, I, and we take it for granted. So the idea is that tests and measures absolutely help you establish a baseline and determine if there's room for improvement or they're functioning at, or near where you would expect them to function based on the severity, the course, the interplay of these disease processes. And then that helps you pick which course of care restorative or improvement, stabilization, or maintenance. And then you have to say, this is what my skills are going to be medically necessary for. So, so I'm going to tie that now to the next thing that comes, because if we get people this far down the myth-busting trail, Karen, the next thing they say is, well, how am I going to write a goal for that? I mean, if I'm not going to write something to improve, I mean, our, our documentation is called progress notes. I mean, you want to see how addicted we are. That's Cindy's line, right? We write on progress notes you know, Cindy, talk to us about goal statements. How can, how can maintenance patients actually have a goal statement if they're never going to get better? Speaker 2 (15:43): Well, I think, you know, we talked, we talked about coverage criteria, and then the documentation piece goes with that because I can't, and I'm going to kind of work backwards because what we'll see at times is therapists kind of go, okay, I understand it. And then you go to the goal statements and every one of them says, maintain this to maintain that I'm maintaining strength to maintain ADL's. And it's kind of like, okay, let's, let's take maintenance out of it for a minute. That that doesn't measure anything. What ADL's are you talking about? You didn't give any sort of quantifiable way to say what you're trying to maintain. So the goal solution is not to stick the word maintain in there as many times as humanly possible. It's still looking at it as we should be looking at it is what is that quantifiable element? Speaker 2 (16:29): How am I measuring something so that I can demonstrate whether or not we've improved it or stabilized it or slow the decline. And then the end piece is how was this functionally relevant to the patient? So I think what happens at times when D and I work with agencies about writing goal statements for maintenance, the by-product is actually their goal writing overall gets better. Because I think we've lost focus. We think, oh my gosh, I have to have an HCP goal, right? Because that's another addiction, you know, patient will have, you know, visual be independent with Hep. Well, it doesn't say what it's for. Why do you tend for them to do it forever? We don't know, but you have to have that goal. Then you have to have a strength goal. So, oh gosh, this has maintenance. I'm going to put, you know, increase a quarter grade. And yes, Karen, I have seen that documentation, the plan to increase one quarter grade, it's like, can you just go to maintenance and stop trying to improve in minuscule, teeny tiny amounts? Speaker 1 (17:27): How, how is that measured? I Speaker 2 (17:30): Have no idea. I thought half a grade was bad, but then we get into quarter grades. We see assessments that contain the terminology of severely poor. I thought poor was like the basement. I didn't know there was a tunnel under the basement. So this goal writing is really a good place to say, am I focusing in on, what am I quantifying? Why is this functionally relevant to this individual? Then we're setting the stage as to why therapy is in fact necessary for this person. I think the, I will maintain this to maintain that. Doesn't really speak to that. And then we'll go see, I got a denial. That means this whole thing is, is self fulfilling prophecy. They don't pay for maintenance. I will never do this again. And it's like, yeah, but did you really cover what you needed to cover and speak to why the therapy was important and why they needed to have it now? Yeah. Oh God, Speaker 1 (18:24): No. I was going to say, that's great. Thank you for that. Speaker 2 (18:29): But I think the extension of that, and I guess my way to push the ball back to D here as it were, is okay. So I've assessed them. I did my test and measures that wrote some goals. Now the issue becomes, I got to establish a care plan. So how often am I going to see them? And this is where at times, you know, when we had the ability to see folks in person, I swear people's heads are going to start spinning around in confusion because we start talking about things like you don't necessarily see these folks every week. You may see them once a month. And then D what about PRN visits? Can, can therapy use visit frequency? I mean, don't, we have to go or see them or interact with them at least once a week or else this won't be paid for. Speaker 1 (19:14): So talking about service utilization, you know, it's my answer is it depends. What does the, what does the beneficiary, what does the patient need, right? And so do I have to go three times a week for them to stabilize function? Do I have to go once every three weeks? What does it take? What is it that I'm doing that is indispensable for them that only can be provided by a therapist? You know, they can't go to the local you know, green, orange theory and have somebody work out with them in the gym and get the same benefit. What, why, why do you know, why does it have to be me? And so we, so we have to have an understanding of what's it going to take? How often do I have to go? And so when Cindy's talking about PRN visits, that's like a big no-no in home care for therapists, right? Speaker 1 (20:04): Under the Medicare part, a benefit in reality, it's not nurses do it all the time. You know, when they have to adjust Coumadin levels, right? For, or blood thinners, when they have to, if people still even on Coumadin, when they have to do sliding scale insulin adjustments, when they have to run labs, when they update or they're changing wound care orders, they write PRN visits all the time, but supposedly therapists can't do that. Well, that's not true because think about it. I think in, when I'm making this care plan, I'm not writing everybody for three weeks for I'm writing this person in five times a week, because they just got out of the hospital for an elective surgery. And I'm going to go every day, because if they went to an ER for SNIF, rather than home, they'd probably get daily therapy. Right. Okay. And this person was referred from maybe from their physician. Speaker 1 (20:54): And, and we're in the second episode of care, if you will, the second certification period. And there were still as ensuring that they are being, that they're stabilizing function. They're still teaching training oversight, checking, following up on 30 day reassessments to confirm that our interventions are actually working well, if I'm waiting on a piece of equipment, maybe that I decided, okay, we're going to get them a splint or something to meet, or we're going to get them this, this device. And we have to go through all the machinations with DME. I could write that I'm going to go out one time a week for four weeks. But what if that device doesn't come in for two weeks, what am I going to do? Just go, yada, yada yada. And the second week of that 30 day period, or do I just write like a PRN visit that says, you know, when the device comes, if it's not a, you know, when I would normally go out, if it's not going to be there, when I'm planning to go out, I'm not going to let it sit in my office or the back of my, you know, the boot of my car for another week. Speaker 1 (21:52): Or I'm not going to write an add on order. I'm going to have this PRN, but well, it's come in. I wasn't planning on seeing you for a week. I'll bring it out there, fit, adjust it, set it up, teach you how to put it on Don and doff it, you know, check your skin, how to wear it, everything you need to do. It's the same thing. Think about when you think about Karen, when you tell your patients, oh, Hey, if you have a problem with this exercise program, give me a call. How many calls do you get? I don't get that many calls. And then I go back out there and they're doing like rhythmic gymnastics with the Sarah band. And I'm like, that's not what we taught you. Right. That's not the correct exercise. So, so this is a way this, this kind of go out as often as you need to, and not one visit more is appropriate, not just for maintenance, right? Speaker 1 (22:37): So, so writing, writing utilization is really hard for people to understand, because they're used to seeing their patients every week and that doesn't sometimes have to happen. How long do you have to wait to see if the exercise program was efficacious two weeks, three weeks, four weeks, how long, you know, you've got to base it on what, you know, what the evidence shows us? What, what, what our, you know, our, our scientific literature says that's important. So, so I have one more myth to kind of finally push the ball back to Cindy since utilization depends. So now we've got people test to measure some kind of goals that aren't just written, maintain. We have utilization. That seems to be very beneficiary specific, Cindy now, cause they're on maintenance. I got to see them for the rest of their life, right? Speaker 2 (23:29): Yeah. That that's, that's very common and, and it kind of splits into different ways. Karen, sometimes it's the, I made a lifelong commitment because they could decline at any point in time. So by that standard, this is forever or there's the gleeful hot maintenance, a great way to go for patients that don't want to be discharged. So as opposed to them crying, when I talk about discharge or the daughter runs back to the doctor and keeps getting orders, I'll just put them on maintenance and then everybody's happy. Okay. You can't do either one of those things you still are accountable to skilled, reasonable, unnecessary. So the benefit is clear. You can't just keep going or having them come to see you at the clinic, just because you're nice. This does need to require the skills of a therapist. We're still accountable to all of those criteria. Speaker 2 (24:19): And as di said earlier, if there's nothing left to teach, train, or do I can't just do it because you either don't want to, unless I stand here or the caregiver doesn't want to have someone else can do it just as well as I can, that this is no longer considered skilled. And that's what drives the decision to discharge as well is when I have taught you what I, everything that I can the program I've given you is effective. It is in fact stabilizing function. There are no more adjustments to make. There are no things that need to be changed, then you really don't need me anymore. And that's where I think that it comes back to again, how are we finding our value that I think we've gotten very used to. They come to see us X number of times per week for this number of weeks in a row. Speaker 2 (25:07): Then we say, okay, you're done. The order is done. If anything goes wrong, then come back again. Where maintenance really makes us think about a term we use very often is how are we dosing ourselves? So thinking about ourselves, like a medication, when do they actually need that encounter with a therapist? And when we've reached a point where you don't need it, there's nothing I'm doing that is uniquely therapy, then we need to stop. But I think the hard part in that, Karen is some of our skill and touched on one, oh, I had just a piece of equipment in the family looks amazed because that is a skill. You, you know how to do that because of your training. I think sometimes the decision to discharge, we jumped the gun too fast, whether it's a maintenance approach to care or restorative by this. Oh yeah. Speaker 2 (25:53): They got it. They understand it. I don't really, you know, they're just doing the same thing, but are you still contributing something? Are you still making any sort of adjustments? Are you convinced? Because on the restorative side, I've never understood these, you know, lofty strength and improvement goals for a two week care plan that suddenly, you know, the, the they've gained a whole muscle grade in two weeks. I don't know what literature I missed, but this, this, this will be great because I'm going to go join a gym for two weeks when it's safe for me to do so. And then I will be fixed in two weeks. It's all done. So I think it, again, challenges us to think about, have we done everything that we can, are we confident as do? You've said more than once. I mean, we've taken care of mitigating concerns. Speaker 2 (26:37): I mean, if they may have a completely unexpected stroke next week, I'm not expected to be telepathic, but I have looked at your condition, given you the tools and resources. And in fact, whether there is nothing left for me to adjust to do, I am going to discharge. So there is active discharge, planning and maintenance care. We are, we are not saying because of this decline risk, then I'm here forever. And we also have to be careful because a lot of beneficiary advocacy groups have done a great job, educating our patients about this, who will then come at us with the resource. You can't discharge grandma because I've got this GMO thing. And it says, you have to, that's where I think some therapists have gotten caught and been like, oh, okay. That looks like an official document. I'm going to keep having you come to the clinic. I'm going to keep seeing you in the home. And it's like, wait a minute. That's why you have to know what the rules really are because yes, beneficiaries should be educated, but they don't necessarily understand the coverage criteria very well, just because they want this to continue. Doesn't mean it's automatic because of that, Jim. Okay. Speaker 1 (27:43): Yeah. And I think that that is where your judgment as a physical therapist and as the authority figure in that situation, you really have to come down from on that and, and be able to explain exactly why you're making that decision instead of just being like, oh, okay. I guess I'll just keep seeing the men, even though it's at this point, not medically necessary. So what, what advice do you have for the physical therapist who might be in that situation? How do they then speak to the caregiver, the patient, et cetera. So that's, that's happened to me cause I've been providing maintenance therapy. When I had my Medicare certified agency in central Florida, way back 2008, 2009, been doing it a long time because we get tired of people. We get them better and then they'd go off and then they decline and then they come back on. Speaker 1 (28:41): I'm like, we're missing something. We have to be able to monitor these people. I watched nurses do it all the time with the monthly catheter changes, right? Because most people are not good at self cathing and preventing infection and doing it accurately. So they'd end up in the hospital, you know, with some sort of puncture or something or an infection. So, you know, monthly catheter changes can happen for years and years with nurses. So what were we missing here? Here is the bottom line for clinicians. I, when I have taught and trained everything and my skills are no longer necessary. You ask yourself, is there somebody that could oversee that could carry this out with you? Because it really just requires sometimes the assistance of another person or a cheerleader or somebody to motivate you or supervise you. What we have a lot of patients that might have cognitive and limitations. Speaker 1 (29:31): And even if that person isn't available, just imagine, just ask yourself the question. If that person holographically appeared in the room, right, and said, teach me train. And they were capable. Would you give it to them? And if the answer is yes, then you should no longer be going anymore. So what I tell patients is I will say to them, I understand that you want me to come, but as a licensed physical therapist, I have a fiduciary responsibility to the payer and the payer has requirements. And one of them is medical necessity. And at this point you need to do this, but you don't need me as a physical therapist to do this. So I can teach and train you, your spouse, your family member, a paid caregiver, or you can pay me to come, right. But I cannot bill your insurance for this because I would be in essence, fraudulently saying, it's still required. Speaker 1 (30:27): My skills, knowledge and ability when I'm telling you it doesn't, it just requires another pair of hands or somebody that could be shown a lay person, how to do this. And so they're like, oh, well you calm. And then I'll tell them, this is what it costs to privately to pay for a physical therapist. And some people take me up on it. And some people say, oh no, I'll get my grandson to come over. Can you show him how to do it? And I'm like, that's great. So, so I think we have to, like Cindy was saying, we have to understand the regs. We have to understand this. Doesn't go on forever. We have to understand that when we are going to sign our name with our credentials, so hard earned right through through education and practice that we are basically signing an affidavit. If you will. Speaker 1 (31:13): That says, I attest that this meets the requirement of this third-party payer. If Benny therapists stopped, many clinicians heck stopped and thought about that. They might not provide some of the services that they're told they have to provide or do the things they have to do, but it's really comes down to our license. So when I sign that and say, this is medically necessary, I I'm going to make sure that I show that my skills and my contribution to that visit is a billable visit. If I no longer have needed for that, then I can teach and train someone else, or I can discharge them from the third-party payer and they can pay me privately. They could, it can be a cash based service. And that has happened. Speaker 3 (31:56): Yeah. Yeah. That Speaker 1 (31:57): Makes so much sense, guys. This was so good. I just know that therapists are going to have a much better idea of what stabilization care is versus maintenance care. We won't use that term anymore. Maybe we can, we can change that preservation of function, care stabilization of function, carrot just, it sounds it's. I think it sounds better for the therapist and quite honestly, like more humane, more human for the person that we're caring for. Instead of just maintaining someone, you know, we're preserving their function, we're their ability to do the things that they want to do. Just sounds so much more, I don't know, human than maintenance care. It sounds so cold and sterile. I don't know. Maybe it's just me. No, I think, you know, for me, when you say that, it makes me think that we are helping patients be accountable for their chronic disease management. Speaker 1 (33:01): Right. We are teaching them what we know and how important it is for people with aerobic impairments that they have to maintain that lung capacity you know, within the confines or the constraints of that disease process so that they can continue to do their self care, which is metabolically demanding. Right. So, so it, it really, it really shifts responsibility. I think maintenance is a very passive sort of thing that, you know, we're, we're maintaining range. You know, I, I think you know, people that were doing stuff to versus where we're in we're we're arming people with the ability to manage and be accountable for their chronic disease and to, and to function optimally within the constraints of those, that disease or those diseases through a stabilization or preservation of function. Yeah. Speaker 2 (33:55): And I think it's important to, to just kind of circle back a minute that we don't want the visual now to always be maintenance patients or stabilization patients are very debilitated, have to have a caregiver, very ill individuals. These, we can teach these types of programs to the patients themselves, for them to self manage. I think sometimes, you know, okay, I'll give it up. It's not Parkinson's ALS and Ms. I got that point, but these must be like really sick, bad off people. They might be, but they might not be, they might be the heart failure patient that's functioning pretty well right now, but has a history of pushing themselves too hard. So the now kicks in the fluid overload. It ends up back in the hospital because they're overdoing. How do you better task plan? How do you help someone understand when their disease process gives them good days and bad days? Speaker 2 (34:45): What, what do we want them to do on a good day? What do we want them to do on a bad day? Because we know many of our folks that are receiving therapy. Cause they basically think that we're gym instructors, we're gonna, you know, show up for the treatment, wearing spandex and tell them to drop and give us 20 anyway. So we're trying to get past that, but on a bad day, too many of our patients, regardless of diagnosis, sit and wait until they feel better, maybe, you know, with a recent orthopedic surgery, a little bit arrest, okay. We encourage some rest. That's not a problem. And some of these chronic diseases, you're one day turns to two days, turns to a week, you haven't done much of anything and now you've compounded the problem. So I think you're right. It does feel like we're utilizing our skills in a more person focused way meeting them where they are. Speaker 2 (35:34): But I think, you know, very often just briefly we'll get the, well, what are the treatment interventions for maintenance you didn't in this whole conversation, give us any treatment strategies because it's not about the treatment. It's not about the assessment. We do what we do. We have the tools in the toolbox, but what, what are we trying to get to? What is the end vision for this individual? And then I'm going to utilize what I know how to do best in that context. I just think for a lot of us, we felt that door was never open. That you were not supposed to do that. That if you could not show significant improvement that you had to discharge and Dee and I have seen therapists, when you see the wheels turning, I've said a couple of times we need to develop like a stages of grief equivalent for the discussion of maintenance, because we'll have people get mad. Speaker 2 (36:21): Like I can't believe nobody told me this. And then you'll see guilt, you know, oh my gosh, I've had patients and I discharged them. I thought I was doing the right thing. I'm a horrible therapist. What am I going to do now? And it's like, okay, let's just start looking at the information and change what we do going forward and not go backward and be all upset and think we're horrible or mad about who lied to me. It didn't tell me about this before, but we do need to start making a difference. Cause D and I heard far too often, you know what? That was interesting ladies, but we don't do that here in this clinic. We're not going to do maintenance therapy. And it's like, wow, you just get to unilaterally, decide you're out. If you want to be out, that's fine. But then you want to direct them to a clinic that does do it because if they need it and they qualify for it, then find them a provider who will, but this kind of, oh, I never heard of it. I'm not participating thing is, is very frustrating in the current environment. Speaker 1 (37:14): It's, it's not correct. I mean, we have to understand beneficiaries have paid into this benefit. They are entitled to it. And if their presentation is such, that stabilization of function is the appropriate course of care. They are entitled to it. It is part of their benefit package. You don't have a right to say, oh, we'll take you on care. But you know, you're not going to get that. That that's that's you, you can't do that. I mean, you either provide the care that is within the insurance. Right? I mean, think about it. If you went to Jiffy lube for your 32 point checkup and they charged you 90, 95 and, and you only got 10 of them because that, oh, we don't do those other 22. Would you be paying for, I wouldn't as like, listen, I'm entitled to this. This is what I'm appropriate for. Speaker 1 (38:07): It's part of my benefit. Maybe you don't do it, but you can't determine that I don't get it if it's part of my benefit package. So it really comes back to the beneficiary. If they're entitled to it, we, as professionals are not ones to say, we can recommend and say, I don't think that's the appropriate course of care. But to literally say, we're, you're not getting that component of your benefit. I don't think that would go over very well. Do you care? Do you not? No, not at all. Not at all. Especially with, you know, like you said, people have been paying into this, their whole working lives. If it is part of the benefit you should offer it. For sure. And if you're a physical therapist who says, I don't know how to do that, well, you better get educated and learn how to do it. Speaker 1 (38:56): Exactly. The things that I am not the most gifted at as a therapist. So I'm not just going to start dabbling in dry needling. Okay. That's that's not my area. Oh yeah. Just give me some, you know, go into the pin cushion and let me start working on you. It's a skill set and it's something that you have to understand the rules and regs. You have to understand what the payer source requirement is, but we as clinicians don't need any other evaluation skills. We don't need any other tests and measures. We don't need special interventions. What we need to understand is that there are times that we are indispensable to help people improve and recover function back to a prior level or maybe beyond. And then there's times we are, we are needed. We are indispensable to preserve and stabilize their existing function so that their quality of life can continue on in the fashion that it currently is perfect. I was going to say, do you want to button it up? But I feel like that did it, but now listen, before we wrap things up, let's talk about the book, the guide to the two delivery of home-based maintenance therapy. So talk about the book, where can people find it? And what will they get out of the book? If people go and purchase this book, what are they getting? Speaker 1 (40:16): Well, they're going to get DNA, Cindy. That's what I'm going to start with. They're going to get us, they're going to get us. They're going to get an updated version. I think it's the only book. And actually it's our second edition and really focused on community-based care part a and part B for Medicare, right? Whether it's part B in a clinic or part B in the patient's home. And we really focus on the rules and the regs. And we and, and literally walk you through common case scenarios. We try to myth bust, and we try to give you a how to like how to start to think about this, because I think theoretically or conceptually when, Cindy and I talk about this and we've been talking about this for eight or nine years now. And teaching on this, people don't disagree with this. They fundamentally understand, they just don't know how to operationalize it. They don't know how to, if they see it. Okay. Well, I understand what you're saying. I understand. I, I agree with you. That would be, I could see where that would happen, but then how do I do these things we've talked about? So Cindy, what does this second edition really afford them? This time around that, you know, it was kind of like a value. Speaker 2 (41:30): Well, I think part of it came from, we were folks, as you just said, understand the concept, but then struggling to say, I got chew on this for awhile. This is really going to change my core, that I am not just defining myself by improvement. I got to work through some stuff and figure out how to do that. And so our first edition started out. We have a consistent scenario throughout to really talk about assessment and goal writing and detail and all of those pieces. But then as we looked at the second edition, we said that that's a good place to go. You got a nice, consistent scenario. It builds throughout the entire book. So you have opportunity to do that. But then this time around you know, I think you got the sense. I tend to be more in the regulatory nitpicky, wheelhouse, and D tends to go toward the operationalization side. Speaker 2 (42:18): And so she brought up, why don't we put a workbook with it? Why don't we add to that idea of a consistent scenario and say, what are some additional knowledge application activities? How do you comment that same thing about assessment or goal writing a little bit differently than one scenario to really get the juices flowing about how to do this. Now, the challenge is, is there a right answer? Like, do I just go to the answer key? And there was only one way that could have been done while listening to this conversation. There was quite a few, it depends. How often would I go? What would I focus on? So the answers give you some context, some suggestions, some validation, but it was not meant to be, there's only one way to do this. And in a scenario, you know, five sentences long, you better figure out exactly what you would do all the way through this only one path, but it's really to help kind of put those guard rails on and say, well, did you think about this? Speaker 2 (43:14): Or what about that element to, to be able to say, okay, I am understanding this. So I could use that as an individual to go through that process, or I could use it in an organization and do it as a group activity, but to really help people continue to process what sounds like. Yeah, I got it. But now I have a patient in front of me and, and I'm still stuck. Old habits die hard. I still struggle with the goal. I still think I can fix this. I, I still feel that voice in my head. That's telling me if they're not getting better, you're not supposed to be here. So people need that opportunity. So we wanted to provide that in a tangible way that, you know, doesn't really lend itself to an educational event unless the thing was days and days long, and people camped out with us, which nobody wants to do. But gives them that opportunity to come to step away, think about and come back to it at their own pace. Speaker 1 (44:07): Awesome. And just so everyone, all the listeners out there the book, the guide to delivery of home-based maintenance therapy, it's on the Kornetti and craft website, but we will have a link that takes you directly to the book and, and listeners. If you use the coupon code KK 2021, you'll save percent on your purchase. We will have all of that at the show notes at podcasts on healthy, wealthy, smart.com under this episodes, you don't have to remember it. You don't have to send everybody DMS and things like that. Just go to podcast at healthy, wealthy, smart.com click on this episode, it'll be under the resource section in the show notes. So we will make it very, very easy. That's all you got to do is one click, and it'll take you right there. So now before we wrap things up, the question I ask everyone on the podcast is knowing where you are now in your life and in your career. What advice would you give to your younger self? Speaker 2 (45:19): Come on Cindy? I would say, well, I, I would say to my younger self to be a bit more open-minded with how physical therapy really works in reality. I think career-wise would come out. I came out very, this is what I'm going to do. And, and briefly my goal is I'm going to work in a traumatic brain injury unit. I loved working with that population as a student, I'm going to be a famous therapist in a big old rehab facility. And now I'm going on nearly 30 years in home health and have never actually worked in a, in a fancy schmancy rehab clinic. I started this kind of on the side, fell in love with it and never went back. I tell, I tell students all the time, don't assume that what your path is at the moment is the path and can't vary and can't change whether you go into teaching, whether you go into other avenues there's a lot more possibilities and it took me a little while to process that piece to say there, there are many other ways you can utilize your skill to benefit those around you. Speaker 1 (46:28): Excellent. D I would say to my younger self I may not come across that way now 30 going into my 36 years a PT, but I would say don't be afraid to ask questions and don't think you have to know it. All right. So I, I think that I kind of stayed in my box a little bit more and got really, really good at what I did. Some of that time, Cindy was in a traumatic brain injury a locked unit and I got very good at what I did, but I had a lot of questions about, but what if, but why not? Right. And I think sometimes I kind of just that maybe I shouldn't ask that question. I was a little bit too con you know, self-conscious about it. And so I, I think the idea is ask those questions, be fearless. Speaker 1 (47:18): And, and instead of asking, why would I do that? You know, look around. Why not? You know, I'm a big, why not, if you've got a great idea, you have something that is like a passion, and you've got that intersection of your passion and your skillset go for it. Right. A good friend of Cindy and mine Dr. Tanya Miller started event camp for kids. Like when she was like a new grad PT. It's like in it's what, 27th year. And she's written grants for it. And, you know, they take these kids on ventilators out in kayak. I mean, you can do it, you can do it. So be fearless and don't be afraid to ask questions. Don't don't, don't think, oh, well, I don't know as much as Karen Litzy or I don't know as much as Cindy craft, you know, start to explore that the possibilities are endless. That's what I would have told myself when I was younger, fabulous advice from both of you. And I couldn't agree more. Thank you so much for coming on for sharing all of this great information and your book, and it's just sounds great. So thank you so much, Dee, and thank you so much, Cindy, for coming in. Thanks for having us, Karen. It's always nice talking to you. Pleasure. We had a great time. Excellent. All right. And everyone who's listening. Have a great couple of days and stay healthy, wealthy and smart.  

Advocating for patient rights: the Jimmo Act Linda Strohschein is an estate planning and elder law attorney. Linda, Fran and Sue discuss long term care planning and the impact of the Jimmo Settlement Agreement. Jimmo clarified when a beneficiary needs skilled nursing or therapy services under Medicare.    This is a production of Habanero Media 

Join Nishi Langhorne and Kathleen Otal, co-hosts of the podcast Invitations to Listen, as we interview Lynn Jimmo, fourth grade teacher at Union Mill Elementary. Lynn shares her experiences growing up in a multicultural military family, how being authentic and honest has helped her as a teacher, and how she balanced two jobs while raising her daughters and getting her Masters degree. Subscribe to the podcast on iTunes so you know when our next episode is released and leave a review because your feedback counts! Podcast website: http://invitationstolearn.com/ Twitter: @MrsLanghorne @KathleenOtal Email: invitationstolearn@gmail.com

Jeff Jimmo is the head coach at his mma gym Gym-O in Gastonia NC. The gym really is a hidden gem with its very own mma yoda leading the way. Jeff has years of experience in many martial arts backgrounds with a non stop learning mentality to be the best he can be for his students and everyone around him.

The team head on a mission to Mars to obtain an important navigation device. With a ship upgraded and a new lead on the next step to halting a galactic invasion revealed, our crew set space-sail for the Sol system, and the red planet where Dora and Jimmo have historically engaged in some blue activities. Join us as we speculate on the whereabouts of beloved Season 1 characters, listen to our Millennial players try and decipher what it means to ‘Yeet’ (again), and discover the origins Big Condiment doesn’t want you to know about in this episode of Espersito. Welcome to our Esper Genesis podcast, telling the brand spanking new story of an unlikely group of galactic nobodies caught up in something far bigger than they expected. Listen as their tale unfolds and they find new and exciting ways of making the games master despair. This truly is D&D in spaaaaaaaaaaace.   Think science fiction. Expect to find; Star Wars, Star Trek, Stargate, Battlestar Galactica, Farscape, Firefly, Rick and Morty and Red Dwarf. Esper Genesis is a science fiction TTRPG compatible with Dungeons and Dragons 5e.   Credits: Jon Coleman (GM), Aaron Madray (Colm ‘Hudd’ Hudnarajan), Mike Cole (Aldora the Explorer), Tom Owen (Rebook Ungart), Tom Kirk (Dumas Corriban) 

With an attempt at vengeance foiled, the crew settle down for a hearty (or rather a heart-disease-y) breakfast and a day of politics. Jimmo’s culinary skills are put to the test as he serves up his speciality of BLTs (without the L, the T, or the bread - so just the B, really)*. As the Dwarves surely continue to question their selection of representatives, our not-quite-heroes talk politics with the Dendus council, discover more of the insectoid menace, and meet a doctor who has both a ‘glorious form of schizophrenia’, and foreboding words for the mission ahead... Will our misfits continue to be belligerent in a diplomatic setting? Of course they will! In the next episode of Espersito! Welcome to our Esper Genesis podcast, telling the brand spanking new story of an unlikely group of galactic nobodies caught up in something far bigger than they expected. Listen as their tale unfolds and they find new and exciting ways of making the games master despair. This truly is D&D in spaaaaaaaaaaace.   Think science fiction. Expect to find; Star Wars, Star Trek, Stargate, Battlestar Galactica, Farscape, Firefly, Rick and Morty and Red Dwarf. Esper Genesis is a science fiction TTRPG compatible with Dungeons and Dragons 5e.   Credits: Jon Coleman (GM), Aaron Madray (Colm ‘Hudd’ Hudnarajan), Mike Cole (Aldora the Explorer), Tom Owen (Rebook Ungart), Tom Kirk (Dumas Corriban) *Sorry, I had to fit this in to make the particularly terrible pun 'work'. - TomO

A hilarious podcast on Sports, HipHop, and College life Hosted by Jordan Perkins & co-hosted by Justin Collins and Jimmo.

Tim is an Assistant Meat Manager at Shaw’s Supermarket. He and I cover a range of topics including: His tenure in retail. Why he chose the Meat Department. The most frustrating aspect of working with the general public. Customer interactions, the good and bad. The most positive experience he’s had professionally. His ability to evaluate potential talent. His self care approaches. Best part about being a father. Misconceptions about parenthood. Improvements as a father and much, much more!

Erin Thomas, a physical therapist with Fox Rehab explains about the Jimmo Settlement.  This court case opened the door for Parkinson’s patients to finally not be restricted in the number of visits for physical therapy.

In this episode of Eldercare Illuminated, host Lenore Tracey and elder law attorney Cathy Sikorski shed light on an enduring misunderstanding about Medicare coverage for skilled services.For years, Medicare recipients have been denied coverage for services, such as skilled nursing, physical therapy, and occupational therapy, based on the notion that they have plateaued or there is a lack of restoration potential. For example, patients were told (and are still being told) that Medicare would no longer pay for physical therapy because there was no potential for improvement in their condition. Perpetuated for years, this notion has resulted in patients not getting needed services to which they are entitled and from which they can benefit.Cathy shares the facts and the strategies you need to dispel this myth and advocate effectively for your loved one. Listen and learn. Then check out additional information from the Centers for Medicare and Medicaid Services (and print materials to bring with you) so you have all the information in hand if you need to get your loved one’s providers up to speed.1. Updated Publication from CMS (Centers for Medicare and Medicaid Services), because federal court found that 'virtually no effort' was made to promote the Jimmo vs. Sebelius settlement. https://www.cms.gov/Center/Special-Topic/Jimmo-Center.html 2. Frequently Asked Questions associated with the above publication: https://www.cms.gov/Center/Special-Topic/Jimmo-Settlement/FAQs.htmlCaregivers, you make such a difference in your loved one’s lives!About Our Guest:Cathy Sikorski has been a caregiver for the last 25 years for seven different family members and friends. A published author and humorist, Sikorski is also a practicing elder law attorney. Her legal expertise and sense of humor have made her a sought-after speaker where she tackles the legal issues that affect those who will one day be or need a caregiver (which is everyone).Cathy’s first book is a humorous memoir Showering with Nana: Confessions of a Serial (killer) Caregiver. That was followed by Who Moved My Teeth? - a humorous and informative book with practical and legal tips for caregivers and baby boomers. Cathy maintains an active blog “You just have to Laugh…where Caregiving is Comedy…”.

In this episode of Eldercare Illuminated, host Lenore Tracey and elder law attorney Cathy Sikorski shed light on an enduring misunderstanding about Medicare coverage for skilled services.For years, Medicare recipients have been denied coverage for services, such as skilled nursing, physical therapy, and occupational therapy, based on the notion that they have plateaued or there is a lack of restoration potential. For example, patients were told (and are still being told) that Medicare would no longer pay for physical therapy because there was no potential for improvement in their condition. Perpetuated for years, this notion has resulted in patients not getting needed services to which they are entitled and from which they can benefit.Cathy shares the facts and the strategies you need to dispel this myth and advocate effectively for your loved one. Listen and learn. Then check out additional information from the Centers for Medicare and Medicaid Services (and print materials to bring with you) so you have all the information in hand if you need to get your loved one’s providers up to speed.1. Updated Publication from CMS (Centers for Medicare and Medicaid Services), because federal court found that 'virtually no effort' was made to promote the Jimmo vs. Sebelius settlement. https://www.cms.gov/Center/Special-Topic/Jimmo-Center.html 2. Frequently Asked Questions associated with the above publication: https://www.cms.gov/Center/Special-Topic/Jimmo-Settlement/FAQs.htmlCaregivers, you make such a difference in your loved one’s lives!About Our Guest:Cathy Sikorski has been a caregiver for the last 25 years for seven different family members and friends. A published author and humorist, Sikorski is also a practicing elder law attorney. Her legal expertise and sense of humor have made her a sought-after speaker where she tackles the legal issues that affect those who will one day be or need a caregiver (which is everyone).Cathy’s first book is a humorous memoir Showering with Nana: Confessions of a Serial (killer) Caregiver. That was followed by Who Moved My Teeth? - a humorous and informative book with practical and legal tips for caregivers and baby boomers. Cathy maintains an active blog “You just have to Laugh…where Caregiving is Comedy…”.

Listen Now In 2011 a 78 year old blind, amputated Vermont woman, Ms. Glenda Jimmo, was denied physical therapy services under Medicare because her condition was determined to not likely improve. Because Medicare therapy services via skilled nursing, home health and outpatient care never required the patient "improve" in order to receive services and because thousands of other Medicare beneficiaries along with Ms. Jimmo had been denied therapy the Center for Medicare Advocacy and Vermont Legal Aid filed a class action suit against the federal government, i.e., Jimmo vs. Katheleen Sebelius.  After 11 months of negotiations, a settlement agreement was reached in late 2012 that affirmed there is no "improvement standard" required to be met for beneficiaries to receive therapy services.  That is care would no longer be denied due to a Medicare beneficiary's lack of restoration potential. During this 18 minute discussion Ms. Murphy explains the impetus for the case, speculates why DHHS did not act on its own in resolving the problem, how well or effectively CMS has implemented the terms of the settlement agreement (not very well) and why the decision has received so little attention over the past three years.   Margaret Murphy is the Associate Director of the Center for Medicare Advocacy where she works to develop the Center's legal policy and litigation strategies.  Ms. Murphy has been counsel or co- counsel in several of the Center's federal class action suites.  She serves on the Steering Committee of the Complex Care Committee of the Connecticut Medicaid Medical Assistance Program Oversight Council.  She has also been appointed by the Connecticut probate courts to represent incapacitated adults. She has also taught as an adjunct professor at Quinnipiac University Law School.   Prior to joining the Center Ms. Murphy worked for more than 20 years a a trust and estate attorney.   She is a member of the Connecticut Bar Association, serves as the Secretary of the Executive Committee of the Elder Law Section and is a member of Swift's Inn in Hartford.  Ms. Murphy earned her JD degree from the University of Connecticut School of Law and her BA from Mt. Holyoke College.   This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

This is the final episode of Sucka Radio for the year that was -- 2014.On this episode we will air a few of our favorite interviews, along with a recap of the year and a preview of the first card of 2015, UFC 182.The best of interviews include:Michelle Waterson: Prior to her Invicta FC 8 bout with Yasuko Tamada, "The Karate Hottie" talk about how she went from ring card girl to MMA superstar, defending her Invicta FC Atomweight Championship, her thoughts on the partnership with the UFC, her favorite action move and much more.Josh Gow: TUF winner Julianna Pena was injured in a freak training accident and we were the one and only outlet to find out what happened from the training partner of Pena, Josh Gow. He opens up about the injury that occurred while training with Pena, his thoughts on Dana White’s comments, training with women and more about his MMA career.Ian McCall: "Uncle Creepy" was expected to take on John Lineker in Brazil earlier this year, but unfortunately was forced to pull out on the day of the fight. Before the viral infection occurred, McCall spoke to Sucka Radio about the fight with Linker, number one contender status, what he wants to do against Demetrious Johnson in a third outing and more.Ryan Jimmo: Even though this interview went down very recently, Jimmo opened up to Sucka Radio in a way not many do. He spoke very candidly about the lawsuit against the UFC, fighter pay, a possible fighter union and much much more.Rounding out the show, is one of MMASucka.com's original contributor's and now MMA Kanvas writing talent, Justin Faux. "Fauxy" stops by to go over the 2014 news from the world of MMA, as well as breaks down UFC 182.As always you can you can listen to Sucka Radio on Stitcher HERE, iTunes HERE, TuneIn HERE and on MMASucka.com HERE.All that and more brought to you by our good friends at Onnit. Make sure you head over to Onnit and get yourself 10% off with the coupon code “MMASUCKA”

This is a "Big Deal" of an episode of Sucka Radio.Kicking off the show is UFC Light Heavyweight Ryan "The Big Deal" Jimmo. He has been very active on social media this past week and he will explain why. Next up, Justin Pierrot gives us his insights on 'Unpopular Opinions.'Finally, Titan FC 32 main event fighter, Desmond Green stops by the show. He discusses signing with Titan, his opponent Steven Siler, his plans for the next calendar year and much more.As always you can you can listen to Sucka Radio on Stitcher HERE, iTunes HERE, TuneIn HERE and on MMASucka.com HERE.All that and more brought to you by our good friends at Onnit. Make sure you head over to Onnit and get yourself 10% off with the coupon code “MMASUCKA”

Click here to download this episode This episode is an interview of Nancy Beckley of Nancy Beckley and Associates, a rehab compliance consulting firm. We get into the nitty-gritty of HIPAA (and also Medicare) as it relates to a cash-based practice. She fields my questions for over an hour and absolutely fills us with the info we need to protect ourselves and our practices. In this episode, you'll learn about: What exactly is HIPAA and why does it exist How to determine if your practice is a “Covered Entity” and must comply with all the laws and regulations of HIPAA If you are a covered entity, and what to use an eFax, some important considerations for finding the right HIPAA-compliant system. HIPAA-compliant texting software, and when something like this is necessary if you are texting/emailing about patients with other providers. The HIPAA Omnibus changes and how they may have opened the door (in some scenarios) to provide covered services to a Medicare Beneficiary on a cash-pay basis. The Jimmo vs Sebelius case on “Medical Necessity” and how it affects our ability to see Medicare Beneficiaries on a cash-pay basis for certain types of services. Resources and Links mentioned in this episode: Aaron Lebauer's Guest post at this site on HIPAA and determining your  Practice's Covered Entity Status The HHS Flow Charts and Info Sheet for Determining your Covered Entity Status Attorney (and PT) Specializing in HIPAA: Paul Welk Esq., PT PT specializing in HIPAA Policies and Procedures: Angie Phillips, PT S-Fax My article on the HIPAA law changes and seeing Medicare Beneficiaries on a Cash-Pay Basis. Connect with Nancy at her website: www.nancybeckley.com and at Twitter: @NancyBeckley Click Here to learn how to start your own Cash-Based Practice . Let us know if you enjoyed the show: [Click to Tweet] Thank you @NancyBeckley for being an awesome guest on the Cash-Based Practice Podcast w/ @DrJarodCarter Some parting notes: Definitely have a look at the HHS Info Sheet. As I re-listened to this podcast and reviewed that info sheet, I came across a few things that I wanted to point out or re-highlight: Determining if your practice is a HIPAA Covered Entity comes down to whether or not you transmit any “covered transactions” “in electronic form” “covered transactions” are defined in detail on pages 7 – 9 at the above info sheet. Take a very careful look at all the different things that could be considered covered transactions. It does NOT ONLY include transactions/transmissions of payment/billing-related information. Although I don't directly bill any third-party payers for my services, there are still “covered transactions” that I do occasionally transmit. I therefore have to make sure that I only transmit such things in non-electric format. “In Electric Form” is defined on page 9 of the above info sheet. Essentially, Fax is NOT considered “electronic format” so I, and practices like mine that want to avoid being a “covered entity,” need to make sure that the sending of any information is only done by fax. I'm guessing many of you may have questions for Nancy. Please type them in the comments below, and make sure to give as much detail as possible on all factors and components surrounding your question so she has the best possibility to give a clear answer.

Heavy-handed light heavyweight Ryan Jimmo reveals what he did in his spare time during his 20s, his prowess at chess, and how he became an extraordinarily gifted break dancer.

News: - Anderson Silva kicks an Exercise ball while listening to slow jams - Cat Zingano plans summer return - Ryan Jimmo vs Sean O'Connell at TUF Nations Finale Tweet of the Day: .@SpiderAnderson's #RoadToRecovery is picking up steam! http://t.co/7swvYQuTpv — UFC (@ufc) March 10, 2014

News: - UFC returns to Cincinnati - Tito Ortiz's fighting future - Bosse vs Jimmo at TUF Finale - Taisumov vs Prazeres at UFC 38 - Tweet of the Day Documentary on @GeorgesStPierre plays almost like a super-slick infomercial, @stevetilley says. http://t.co/DDx9AZ85zv #GSP #UFC — Toronto Sun (@TheTorontoSun) February 18, 2014

We speak with Canadian 205-lb. UFC fighter Ryan Jimmo about his career and upcoming fight against James Te-Huna. Check it out!

This week on Top MMA Radio, Ryan “The Big Deal” Jimmo joins the show to discuss his performance at UFC 149. Ryan talks about fighting in Calgary and his amazing 7 second knockout over Anthony Perosh. BKB and Big Win also break down UFC 149 in detail and make predictions for the Elite 1, Invicta, […]

On the show was Ryan Jimmo (15-1), the MFC Light Heavyweight Champion as well as one of the best Heavyweight Prospect's in the game, Tony Johnson Jr. (6-1) making his second appearance on the show.