When can a toileting program get billed under restorative?

Q: If a patient is on a toileting program that is designed to meet their needs, can it be billed under restorative?

Diane: A toileting program that meets the requirements of restorative nursing care under Section O, Special Treatments and Procedures and the urinary toileting program under Section H, Bladder and Bowel of the MDS 3.0 then it can be billed under restorative.  (Source: The Resident Assessment User’s Manual Version 3.0 pages H-3, H-4, H-5, and O-23.) 

4 Comments

  1. MARY M. HARROUN

    Dear Diane;
    I have designed a Mobility Assessment Clinic concept that is being used in a huge local county nursing home. After assessing the residents when they come up for their annual MDS review,from all facility modalities, focusing on increasing mobility, weare placing the residents into a restorative CNA Stepping On daily exercise program. The facility is billing Medicare for this service aspart of restorative care.
    We are seeing wonderful outcomes with this program, as we believeit is the first in the country where all staff finally come together to just focus on mobility issues.

  2. MARY M. HARROUN

    By MARY M. HARROUN on March 22nd, 2010 at 10:39 am
    Dear Diane;
    I have designed a Mobility Assessment Clinic concept that is being used in a huge local county nursing home. After assessing the residents when they come up for their annual MDS review,from all facility modalities, focusing on increasing mobility, weare placing the residents into a restorative CNA Stepping On daily exercise program. The facility is billing Medicare for this service aspart of restorative care.
    We are seeing wonderful outcomes with this program, as we believe it is the first in the country where all staff finally come together to just focus on mobility issues.

  3. susan springer

    I am unclear about the “billing medicare” for restorative program.
    what does this mean?
    The only way I know how to obtain reimbursement with the restorative program is when someone is skilled under the PPS and receiving RNA for a Rehab Low.
    Is there something I am missing?
    I am in California.
    Thank you

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