Responsible for moving about 2,000 gallons of blood every day, the heart is one of the most important muscles in the body. A strong, healthy heart can help lower blood pressure and cholesterol, improve blood flow, and prevent heart disease and stroke.

What is the best exercise for your heart? The American Heart Association recommends combining aerobic exercise (walking, gardening, swimming) with strength training (weight lifting, resistance training) to produce the greatest benefit for overall heart health. According to Dr. Levine at UT Southwestern Medical Center, he recommends just keep moving and varying the type and intensity of your exercises each day.

Weekly Workout for a Strong Heart

Making exercise part of your daily routine and finding activities you enjoy can help keep you motivated and moving more every day. *Consult with your doctor about the best way to add activity to your lifestyle.

Therapy Can Help You Stay Active

Exercise is extremely important in managing your health and many common symptoms of aging. Physical therapists can help teach you how to exercise appropriately for joint mobility, muscle strength, and fitness. Occupational therapists can help you safely do the things you want to do, stay active and live well despite limitations.

Talk to your doctor today about the benefits of physical and occupational therapy!


When you accidentally leak urine, it is known as urinary incontinence. Incontinence is a very common issue and more common in older adults. However, urinary incontinence does not have to be a part of your daily life. Treatment options are shown to be effective for many people and may include medications, bladder training, fluid/diet management, environmental modifications, and exercise.

Physical & Occupational Therapy can help you regain control over your symptoms.
Treatment interventions such as behavior modification and bladder retraining can help prevent future urinary tract infections, restore bladder function and greatly improve your quality of life.

Consider the benefits of a rehabilitation program for urinary incontinence. Talk to your doctor about symptoms and discuss a referring order to physical or occupational therapy.

For more information, please contact your on-site Therapy Department to discuss your concerns and treatment options.

Neuropathy occurs when one or more nerves are damaged or destroyed.  This disrupts the nerves’ ability to send messages from the brain and spinal cord to the muscles, skin, and other parts of the body resulting in muscle weakness, numbness, and pain in the affected area.  Frequently neuropathy begins in your hands and feet but can occur in other parts of your body as well.

Diabetes is the leading cause of neuropathy in the United States among other causes.  In fact, it is estimated that 60-70% of people with diabetes experience neuropathy.  Some may experience mild symptoms, but for others, the pain can be debilitating.  If you have diabetes, you can prevent or delay neuropathy by keeping your diabetes under control.

  • Manage Your Blood Glucose Level
  • Frequently Check Your Skin and Feet for Cuts or Sores
  • Wash Your Feet Daily and Moisturize
  • Wear Properly Fitted Shoes that Protect Your Toes
  • Protect Your Feet and Fingers from the Heat and Cold


How Can Therapy Help?

Treatment for neuropathy is often focused on managing the underlying cause and relieving symptoms.  Physical Therapy treatment may be focused on maintaining and improving function through range-of-motion exercises and stretching, strength training, balance training, and pain management.  Occupational Therapy treatment can help provide education on fall prevention as well as strategies to reduce pain and increase mobility.

Source: Cleveland Clinic, The Foundation for Peripheral Neuropathy, Mayo Clinic Foundation

Legislation has been introduced to postpone the 15% reimbursement cuts to PTA and OTA treatments. Please help us to support this bill.

Dear Partners and Friends,

Please take a few minutes to read the below message from NASL regarding the new legislation that has been introduced in the US House. We need everyone to support this bill in order to postpone the 15% reduction in reimbursement for Med B services provided by PTAs and OTAs. This cut is set to happen on 1/1/2022. If this legislation is passed, it will delay this cut until 1/1/2023. Additionally, this bill allows for rural and underserved areas to be exempt from these cuts once they are implemented.

As skilled nursing operators and professionals, I urge each of you to take a few minutes to read the letter, make any additional edits/comments, and submit it to your personal representative. Spending a few minutes of your time could result in a very positive impact for our patients, as well as our industry. Your action is extremely time-sensitive because if this bill does not have enough support, it will not move on.

From NASL: Click here to access the letter and the ability to submit directly to your representative.

The time for advocacy on this issue is now as there is not much time left on the legislative calendar for Congress to act before this policy is implemented on January 1, 2022. NASL has prepared a letter for you to email to your respective House members urging them to cosponsor the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act of 2021 (H.R.5536) and asking them to add the bipartisan legislation to any legislative packages moving before the end of the year.

Use the link above or visit to access and send this email in under two minutes.

Thank you for your time and effort to support this bill!


Cassie Murray, President


Cassie Murray, OTR, MBA, QCP

President of HTS

Healthcare Therapy Services, Inc.

Osteoporosis is the most common type of bone disease in which bones become fragile and are more likely to fracture.

1 in 2 Women Over 50 Will Fracture a Bone Because of Osteoporosis
1 in 4 Men Over 50 Will Fracture a Bone Because of Osteoporosis

How Do We Prevent It?
You can prevent osteoporosis and strengthen your bones by following these health habits…

  • Eat Foods Rich in Calcium & Vitamin D. Calcium improves bone strength and vitamin D helps bones absorb calcium.
    • Calcium: 1,200 mg per day = 2 glasses of milk or 1 yogurt or 2 oz. of cheese per day
    • Vitamin D: 1, 000 IU per day = 7 oz of salmon or 9 oz of tuna or 2 glasses of milk
  • Exercise can strengthen your bones and prevent fractures. To increase bone mass and density, focus on weight-bearing exercises and strength training.
    • Aerobic Exercises: brisk walking, climbing stairs, dancing, hiking, step aerobics, tennis
    • Resistance Exercises: elastic exercise bands, free weights, weight machines
  • Maintain a Healthy Lifestyle. Avoid smoking as it can interfere with proper calcium absorption and limit alcoholic beverages as it reduces your blood serum calcium level.

How Can Therapy Help?
Therapy is an effective, non-surgical treatment for osteoporosis that may help restore healthy movement, function, and bone strength. Physical and Occupational Therapy can help teach you exercises to promote bone health, build bone mass, and ways to manage your daily activities so you’ll reduce your risk of having an osteoporosis-related fracture.

Joint pain is one of the most common forms of pain for aging adults. As you age, the fluid that lubricates your joints decreases and the cartilage that lines your joints becomes thinner. This causes your joints to become stiff, less flexible, and painful to move. Daily activities such as walking, sitting, and, getting out of bed can become more challenging. Poor joint health can significantly impact your ability to move and enjoy your life.

If you are experiencing joint pain and stiffness, talk with your doctor about physical and occupational therapy treatment options. Physical and occupational therapy can help you manage your pain so you can enjoy a more active, pain-free life.

Blog by:  Shelly Maffia, MSN, MBA, RN, LNHA, QCP, CHC, CLNC, CPC-A, Director of Regulatory Services, Proactive Medical Review and Jessica Cairns, RN, RAC-CT, CMAC, Clinical Consultant, Proactive Medical Review

July 29th, 2021, the Skilled Nursing Facility (SNF) prospective payment system (PPS) final rule was released. The rule, which goes into effect October 1, 2021, contained several updates, including factors affecting the usual payment rates, changes to diagnosis code mapping under the Patient Driven Payment Model (PDPM), and updates to both the SNF Quality Reporting Program (QRP) and SNF Value-Based Purchasing (VBP) Program. In addition, there was discussion surrounding the much-debated future PDPM parity adjustment which considers how SNFs will pay back the estimated $1.7 Billion “overpayment” for the first year of PDPM. In this blog, we will take a look at some of the biggest takeaways affecting our business and how to prepare.

Medicare Part A Rates

The Federal Per Diem rates are updated annually and take effect every October 1st. The typical “raise” SNFs receive is over 2%. This October, CMS anticipates a 1.2% rate increase, which equates to approximately $411 million more in PPS reimbursement as compared to 2021. This is based on an unadjusted increase of 2.7% reduced by both a 0.08% forecast error and a 0.07% productivity adjustment. The unadjusted per diem components of the rates for FY 2022 are listed below for both urban and rural providers. Of these rates, 70.4% of each component is adjusted by the wage index, which varies for each core-based statistical area. Listed below are the unadjusted rates for October 1st, 2021.

Unadjusted Federal Rate Per Diem-Urban

Unadjusted Federal Rate Per Diem-Rural

To give you an idea of the daily rate changes [urban] from FY2021 to FY2022, the PT component will increase $0.78/day, OT component to $0.73/day, SLP to $0.29/day, Nursing to $1.35/day, NTA to $1.02/day and the Flat Rate $1.22/day.

Delayed PDPM Parity Adjustment

SNF’s can celebrate this small victory. The parity adjustment was the top concession that CMS made in response to feedback on the proposed rule. This proposed rule left us with the potential of $1.7 billion (5%) parity reduction as CMS data supported that PDPM was not budget neutral as it intended. Said differently, depending on the different component combinations, the rate could have been $10-48.00 per day lower. While we get a pass this year, the rate recalibration will be re-examined in the Proposed Rule for FY2023.

ICD-10-CM code mappings for PDPM classification

The final rule contained updates to the mapping of several diagnoses and where they are classified under the PDPM. Some of the conditions affected include the following:

The FY 2022 PDPM ICD-10 Mapping file is available at

HIV Add-On

The add-on for HIV was renewed and remains unchanged from prior years, including a 12.8 percent increase to the nursing component and an additional add-on of 8 points to the non-therapy ancillary (NTA) component. This add-on is based on claims data containing a diagnosis code for HIV or AIDS (B20).

VBP Program

CMS is suppressing the use of SNF readmission measure data for purposes of scoring and payment adjustments in the FY 2022 SNF VBP Program Year as a result of the PHE. They will use the previously finalized performance period (4/1/2019-12/31/2019 and 7/01/2020-09/30/2020) and baseline period (FY 2019) to calculate each SNF’s RSRR for the SNFRM and assign all SNFs a performance score of zero in the FY 2022 SNF VBP Program Year, resulting in all SNFs receiving an identical performance score and incentive payment multiplier. SNFs will not be ranked for the FY 2022 SNF VBP program.

CMS will reduce each participating SNF’s adjusted Federal per diem rate for FY 2022 by 2 percentage points and award each participating SNF 60 percent of that 2 percent withholding, resulting in a 1.2 percent payback for the FY 2022 SNF VBP Program Year. Those SNFs subject to the Low-Volume Adjustment policy (fewer than 25 eligible stays during the performance period) would receive 100 percent of their 2 percent withhold.

For FY2024, the performance period will be FY 2022 and the baseline period will be FY2019.

Currently, the SNF VBP program only includes the readmission measure. CMS is considering adding additional measures in the future. The table below shows the additional measures under consideration, in addition to these measures, CMS is also considering adding a measure related to staff turnover.

(SOURCE: Federal Register)

Consolidated Billing

Effective with items and services furnished after 10/01/2021, CMS has established an additional category of excluded codes for certain blood clotting factors for the treatment of patients with hemophilia and other blood clotting disorders, which includes those identified by HCPCS codes J7170, J7175, J7177-J7183, J7185-J7190, J7192-J7195, J7198-J7203, J7205, and J7207-J7211. The latest list of excluded codes can be found on the SNF Consolidated Billing website at​Medicare/​Billing/​SNFConsolidatedBilling.


The SNF QRP currently has 13 measures for the FY 2022 SNF QRP:

  • MDS Assessment-Based
    • Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury
    • Application of Percent of Residents Experiencing One or More Fall with Major Injury (Long Stay) (NQF #0674)
    • Application of Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function (NQF #2631)
    • Application of IRF Functional Outcome Measure: Change in Mobility Score for Medical Rehabilitation Patients (NQF#2634)
    • Application of IRF Functional Outcome Measure: Discharge Mobility Score for Medical Rehabilitation Patients (NQF#2636)
    • Application of IRF Functional Outcome Measure: Change in Self-Care Score for Medical Rehabilitation Patients (NQF#2633)
    • Application of IRF Functional Outcome Measure: Discharge Self-Care Score for Medical Rehabilitation Patients (NQF#2635)
    • Drug Regimen Review Conducted with Follow-Up for Identified Issues- Post Acute Care (PAC) Skilled Nursing Facility (SNF) Quality Reporting Program (QRP)
    • Transfer of Health Information to the Provider Post-Acute Care
    • Transfer of Health Information to the Patient Post-Acute Care
  • Claims-Based
    • Medicare Spending Per Beneficiary (MSPB) – PAC SNF QRP
    • Discharge to Community – PAC SNF QRP (NQF #3481)
    • Potentially Preventable 30-day Post-Discharge Readmission Measure for SNF QRP

CMS will adopt two new SNF QRP measures beginning with the FY 2023 SNF QRP:

  • SNF Healthcare-Associated Infections Requiring Hospitalization measure –
    • Will use FY 2019 claims data to calculate this measure for the FY 2023 QRP.
    • This measure will be publicly reported beginning with the April 2022 Care Compare refresh.
  • COVID-19 Vaccination Coverage among Healthcare Personnel measure –
    • Will use data submitted to NHSN by SNFs to calculate this measure with an initial data submission period from 10/1/2021-12/31/2021.
    • Starting in CY 2022, SNFs will be required to submit data for the entire calendar year beginning with the FY2024 SNF QRP.
    • This measure will be publicly reported beginning with the October 2022 Care Compare refresh or as soon as technically feasible using data collected for Q4 2021 and the most recent quarter of data will be reported during each advancing Care Compare refresh.

In addition, CMS is also updating the denominator for the Transfer of Health Information to the Patient PAC measure to exclude residents discharged home under the care of home health or hospice service.

How to Prepare

Make plans to share this information and assess the impact on your facility over the next two months in preparation for the October 1 effective date.

Quick list of action items:

  • Review the rate changes including modifications to VBP adjustments, to determine the financial impact they will have on your organization
  • Incorporate updated rates into your budget and plan accordingly
  • Ensure the billing office is up to date on the current components that affect Medicare rates. This includes ensuring updates to billing software.
  • Discuss the changes in the ICD-10 mapping with the appropriate staff and include the new consolidated billing exclusions related to blood-clotting factors in that conversation.
  • Provide education to clinical staff on changes to VBP and QRP and verify you have processes in place to report all required information.
  • Ensure the infection control nurse has a process in place to report required vaccine information to the CDC.
  • Continue to monitor facility readmission rates and ensure a process is in place to mitigate unnecessary rehospitalizations.



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About Proactive Medical Review
HTS partners with Proactive Medical Review, a third party company who specializes in ensuring compliance with regulatory standards and promoting measurable care excellence. The team includes SNF experienced nurse, MDS, Health Facility Administrator, therapist and reimbursement specialists with experience serving in multi-site contract therapy operations, as corporate directors of quality, clinical program specialists, and Compliance Officers. Proactive is uniquely positioned to assist in managing the many changes and challenges facing providers partnered with HTS. Learn more about our commitment to compliance here.

Everybody falls no matter what age, but for older adults, a fall can result in serious injuries. Knowing what to do if a fall occurs can be helpful to minimize additional injury. We recommend practicing getting up from a fall and fall safety tips to prevent injuries related to falls.

Steps to Take After a Fall

Step 1: Assess Your Injuries
Remain calm, take a deep breath and check for injuries.
Step 2: Call for Help
If you are injured or need assistance to get up, use a pendant alarm or phone to call for help.
Step 3: Get Your Body to All Fours Position
Use your elbows and arms to push your body up to a sitting position. Scoot on your bottom or crawl in an all-fours position towards sturdy furniture.
Step 4: Use Furniture to Pull Yourself Up
Using your good knee, get into a lunge position. Place both hands on the chair. Use your arms and legs to push up onto both feet and slowly rise to a standing position.
Step 5: Assess For Pain
When in a standing position, assess your pain. If you experience any pain, you should sit and wait for help.

Therapy Can Help Reduce Falls & Improve Balance
Physical Therapists provide balance training that targets specific muscle groups and challenges your body to improve your balance and ability to walk. Occupational Therapists can recommend, fit, and provide training on assistive devices and assess your home environment to prevent falls and help you get around safely.

HTS has identified the top 5 therapy clinical outcome focus areas for 2021 based on our experiences from 2020 which allow us to uniquely identify opportunities for clinical growth.


This month’s clinical outcome focus area is:

Part B Programming

One of the many challenges faced during the Public Health Emergency in 2020 included keeping up with the federal, state, and facility specific protocols and strategies to mitigate the risk of exposure to COVID-19. However, with vaccinations and new processes in place based on evolving regulation, utilizing Part B Programming has become less restricted and more able to be optimized. HTS has prioritized 5 ways to maintain quality part B programming in your facility.

1) Take a Deep-dive into Your CASPER
Quality Measures (QMs) are a rich source of information that are recommended to be monitored on a routine basis to assist with quality improvement. QMs directly impact survey results, can influence referral sources and partnerships, and could even be a factor for pay-for-performance which may be where the future is headed. QMs are based on indicators of the outcome of resident care based on resident specific information from MDS assessment information as well as a few claim-based measures.

QM reports are available through the CASPER report system. The CASPER Report MDS 3.0 Resident Level Quality Measure Report identifies all residents, active and discharged, who were included in the QM calculations. The report indicates which, if any, QMs were triggered for each resident. This serves as an important tool that facilitates detailed record review of residents. The information may be used in QAPI activities, survey process, and to potentially identify rehab need.

2) Utilize a Systematic Approach for Therapy Referrals
We have seen the most success when there are streamlined processes for referring to therapy when changes in function are identified prior to the completion of the MDS. Ideally, the quarterly schedule is distributed to the IDT so that there is adequate time for thorough screening, a physician order, and completion of therapy evaluation(s) before the onset of the assessment period.

  • For example, the MDS coordinator would distribute the quarterly assessment schedule at least two weeks in advance of the assessment period.
  • Then, therapy performs the direct screen as well as collaborates with the IDT to identify any areas of change or skilled need.
  • For patients identified as appropriate for therapy services, the physician’s order is obtained and therapy is scheduled to successfully be captured on the MDS as clinically indicated.

3) Look for Change in Function Through MDS Review
The MDS has several sections that are helpful when identifying potential rehab need. Comparing the last two most recent assessments for change in function is an additional screening strategy that can be used in conjunction with the preferred streamlined referral process. The information can also be used as supportive documentation which can then lead to a request for a physician’s order for a therapy eval and treat as indicated.

  • Sections of the MDS that can be used as supportive documentation for rehab orders (if change is observed) include Sections B, C, GG, H, I, and K.
  • SLP focus example: there are a few sections that can help a SLP identify rehab need. Section K codes for swallowing and nutrition and also weight loss of 5% or more in the last month or 10% or more in the last 6 months.
  • Section K0510C is of particular importance for SLPs. In this section, it is made known if the patient has had a change in texture of foods or liquids. If there has been a recent downgrade, this is something to consider when selecting patients for screening purposes.
  • Some MDS software even have reports that can show any diet downgrades that have occurred in a specified timeframe. This orders report that is filtered by diet changes at the resident level serves as another great screening tool.

4) Implement HTS Proprietary Clinical Programming and Pathways
HTS clinical programs are created and introduced in pace with the expanding needs and legislative changes of our industry. Guiding principles for program creation are contingent upon an IDT approach, person-centered care delivery, quantitative research, and quality measure improvement.

Examples of HTS Clinical Programs & Pathways are available below:

The 3 Most Recently Developed HTS Clinical Programs

COVID-19 Recovery

Most recently, HTS has created a Post COVID-19 Rehabilitation Program. This program was developed by HTS clinical staff in response to a large need of individuals who have recovered from COVID-19 and are experiencing lingering health issues. Ideally, outpatients and long-term residents who have recovered from COVID-19 would benefit from this type of therapeutic intervention.

Fall Prevention

STEADY: Comprehensive Therapy Approach to Fall Prevention was designed to provide the best tools and evidenced-based practices to reduce resident falls and improve safe movement.

  • Therapy-driven program utilized by PT, OT, and ST
  • Reviews 12 areas that lead to falls
  • Use of evidence-based assessments and interventions
  • Patient and caregiver education is a vital component
Quality Measures

Star Quality Improvement Program

Therapy expertise and intervention is a key factor in improving quality. Therapy can have a direct impact on quality and outcomes. The HTS Star Quality Improvement Program focuses on utilizing rehab services to assist in improving specific quality measures. Currently, facility ratings are based on the performance of specific quality measures that are listed on the CMS Care Compare website, previously known as Nursing Home Compare.

Modules include:

  • ADL
  • Mobility
  • Pressure Ulcer Prevention
  • Physical/Medication Restraint
  • Pain Treatment
  • Falls
  • Weight Loss
  • Discharge to Community

Therapy driven IDT programming, pathways, and education facilitate quality HTS Part B Programming

HTS therapists are equipped with clinical programs, pathways, and therapy specific education modules to address functional declines in your building. HTS e-Academy has two on-demand webinars available to HTS therapists to facilitate robust Part B Programming. These webinars are entitled “Quality Part B Programming for SNFs” which includes strategies for physical and occupational therapists and “Quality SLP Part B Programming.” Both webinars include a step-by-step guide to process improvement for your part B caseload as well as all the resources needed to accomplish successful program implementation.

5) Review Benchmarking and Trends with Quality Part B Reporting

HTS Therapy Rehab Managers and Regional Directors use Business Intelligence (BI) which is powered through Net Health Therapy (formally known as Optima). BI reports are pulled on a weekly basis to identify areas of opportunity. Action plans are developed and implemented with the IDT as warranted. Key performance indicators specific to Part B patients include but are not limited to:

  • PT/OT/ST B units per visit
  • Percent of long-term residents receiving therapy services
  • GG outcomes
  • Average length of stay by payor
  • Average length of stay by diagnostic category

These 5 solutions to maintain quality part B programming allow HTS therapists to continue to provide function focused, patient-centered care based on medical necessity. The high caliber of clinically driven HTS therapists paired with HTS Part B Programming and report interpretation uniquely positions us to care for your residents.

Need a Powerful Therapy Partner? Contact Amanda Green, Executive Director of Strategic Development for information about our contract therapy partnerships.

Yardwork and gardening can be very rewarding and pleasurable activities for all ages. Bending, stretching, and pulling weeds from standing or sitting is great physical exercise. However, it can often lead to back pain, sore muscles, joint aches, and injuries…especially for older adults.