Q: I work in a small SNF where we work essentially five days per week and cover weekends/holidays on an as needed basis. If a patient receives only four days of skilled therapy in a week but does not miss three consecutive days (i.e., may have refused or been on hold for one day midweek), does a COT OMRA need to be done if there was no change in actual RTM delivered in the 7-day rolling period? In other words, the patient would still have enough minutes for a Rehab Medium category.
A: If a patient only receives four days of skilled therapy rather than the five days that are required in regulation, you would need to complete the COT assessment. Any change to the reimbursable therapy minutes, number of days of therapy, number of disciplines of therapy, or restorative nursing (rehab low categories) that impact a RUG score necessitates a COT assessment. In your scenario, even though the patient is still receiving therapy, the RUG score would change to a nursing category, because you need five days of therapy to remain in a rehab category.