how often does physicaltherapy need to recertify a treatment plan?

Medicare requires that therapists recertify the POC within 90 days of the initial treatment or if the patient’s condition changes in such a way that the therapist must revise long-term goals—whichever occurs first. Include the certifying party’s NPI on the claim.

Full Answer

When do I need to recertify for Medicare?

And even when things do go according to plan, Medicare requires recertification after 90 days of treatment. If you’re a WebPT Member, you can use WebPT’s Plan of Care Report to identify which plans of care are still pending certification as well as which ones require certification—before those 90 days are up.

What is recertification of the plan of care?

Recertification of the plan of care, which also requires a physician or non-physician signature and date, should occur whenever there is a significant change in the plan or every 90 days from the initial plan of care certification.

How many treatment sessions do I need for my plan of care?

For Medicare Part B, if you establish your plan of care at 2 times per week for 16 treatment sessions, those 16 treatment sessions would need to be completed within 90 calendar days of the initial visit. There is no need or requirement to put a date range for the plan of care (i.e. 03/01/19 – 06/01/19)

When should I recertify for a POC?

Best practice is to obtain a recertification during the initial plan of care, or within 90 days of the initial POC (whichever is less). That way the certification never expires, and there is no lapse in certified care.

How long is a physical therapy script good for?

A valid doctor's prescription for physical therapy includes the doctor's orders for physical therapy, and the duration of those orders. You must use your prescription within 30 days of it being written to ensure its medical validity.

How often are progress notes required physical therapy?

When should progress notes be written? Per the Medicare Benefit Policy Manual, “The minimum progress report period shall be at least once every 10 treatment days.

Does Medicare require progress note every 30 days?

Progress Reports Medicare requires a Progress Report be completed at least every 10 treatment days. The next reporting period begins on the next treatment day after the Progress Report was performed.

What is plan of care in physical therapy?

The POC consists of statements that specify the anticipated goals and expected outcomes, predicted level of optimal improvement, specific interventions to be used, and proposed duration and frequency of the interventions. The POC describes the specific patient/client management for the episode of physical therapy care.

How often should progress notes be written?

once every 10 treatment visitsProgress Reports need to be written by a PT/OT at least once every 10 treatment visits.

Are therapy progress notes required?

Generally speaking, most therapists write a corresponding progress note in their patient's treatment record for every therapy session they provide. However, some therapists wonder whether or not the time that they spend writing progress notes is well-spent, or, whether progress notes are even necessary at all.

How often should therapy Maintenance be reassessed?

every 30 daysThis reassessment must be done at least every 30 days regardless of certification period. Any assessment can reset the 30 day “clock” and satisfy the requirement, so complete documentation on all assessments is critical to maintain compliance.

Does Medicare pay for physical therapy evaluation?

Do I need a referral for physical therapy under Medicare? Medicare only pays for physical therapy if a doctor refers you. It will not cover physical therapy if you are not under a doctor's care.

Do progress notes need to be signed?

While CMS does not require an order for a clinical diagnostic test, the physician must document the intent for each test performed and specify the type of test. The progress notes must contain a handwritten or electronic signature.

Can PTA modify plan of care?

A physical therapist assistant is not allowed to perform the initial evaluation, re-evaluations, change a treatment plan, supervise another physical therapist assistant and/or physical therapy aide or conduct a discharge and discharge summary.

Which of the following may certify a Medicare plan of care?

Medicare states that certification of the plan of care requires a dated signature on the plan of care, or some other document, by the physician or non-physician practitioner who is the primary care provider for the patient.

What is a progress note in physical therapy?

A therapy progress note updates a prescribing physician on their patient's current status towards their rehab goals. This kind of note can also take the place of a daily note, since it follows the standard SOAP formula for daily documentation.

How often do you need to recertify a plan of care?

Recertification of the plan of care, which also requires a physician or non-physician signature and date, should occur whenever there is a significant change in the plan or every 90 days from the initial plan of care certification.

How soon after a plan of care is established should it be certified?

The certification of the plan of care should occur as soon as possible after it is established or within 30 calendar days of the initial therapy treatment. Payment may be denied if the physician does not certify the plan of care; therefore, the therapist should forward the plan to the physician as soon as it is established.

How long does it take to get a verbal order from Medicare?

A therapy provider, per Medicare rules, may obtain a verbal order for certification or recertification of the plan of care; however, the verbal order must be signed and dated by the physician/non-physician practitioner within 14 calendar days.

What is a plan of care for rehabilitation?

What is a Plan of Care. Outpatient rehabilitation therapy services must relate directly to a written treatment plan (also known as the plan of care or plan of treatment). Medicare states "the plan of care shall contain, at minimum, the following information: diagnoses, long term treatment goals, and type, amount, duration, ...

Who establishes a plan of care?

The plan of care is established by a physician, non-physician practitioner, physical therapist, an occupational therapist, or a speech-language pathologist. The signature and professional identity of the person who established the plan of care and the date it was established must be documented within the plan of care.

Do you have to have a plan of care before therapy?

The plan of care must be established before the therapy treatment can begin. Establishing the plan of care is different than certifying the plan of care. Medicare states that certification of the plan of care requires a dated signature on the plan of care, or some other document, by the physician or non-physician practitioner who is ...

How long is a Medicare certification?

The length of the certification period is the duration of treatment, e.g. 2x/week for 8 weeks. In this example the end date of the certification period is 8 weeks, to the day, from the initial evaluation date. In 2008 Medicare changed the requirement for the maximum duration of each plan of care. The maximum length of time any certification period ...

How long can a Medicare plan of care be certified?

The maximum length of time any certification period used to be 30 days, however now it can run up to 90 days.

How to get a POC?

A POC being sent for certification must contain ALL of the following elements to meet the requirements: 1 The date the plan of care being sent for certification becomes effective (the initial evaluation date is acceptable) 2 Diagnoses 3 Long term treatment goals 4 Type, amount, duration and frequency of therapy services 5 Signature, date and professional identity of the therapist who established the plan 6 Dated physician/NPP signature indicating either agreement with the plan or any desired changes.

What are the requirements for a POC?

A POC being sent for certification must contain ALL of the following elements to meet the requirements: The date the plan of care being sent for certification becomes effective (the initial evaluation date is acceptable) Diagnoses. Long term treatment goals. Type, amount, duration and frequency of therapy services.

Can a physical therapist establish a POC?

CMS says either a physician/NPP or physical therapist can establish the POC but if the therapist does it then physician/NPP must approve of the plan. That’s where the signing off on the plan of care by the physician/NPP affirms that the patient is under their care and they agree with the plan.

Can you claim all your patients require the maximum time allowed?

Claiming all your patients require the maximum time allowed may trigger an audit of your documentation. CMS recommends you set the duration for your certifications at your best estimate of the length of time it will take your patient to achieve their goals.

Does a referral count as a POC?

CMS considers a referral from a physician/non-physician provider (NPP) or the Plan of Care (POC) as the best ways to demonstrate physician involvement. However these are not interchangeable. A referral by itself from a physician may not meet the requirements of a certifiable Plan of Care. It can only count as the certification ...

How soon after a plan of care is established should it be certified?

The certification of the plan of care should occur as soon as possible after it is established or within 30 calendar days of the initial therapy treatment. Payment may be denied if the physician does not certify the plan of care; therefore, the therapist should forward the plan to the physician as soon as it is established.

How often do you need to recertify a plan of care?

Recertification of the plan of care, which also requires a physician or non-physician signature and date, should occur whenever there is a significant change in the plan or every 90 days from the initial plan of care certification.

What is Medicare Rehabilitation Services?

Medicare defines rehabilitative services as those services that lead to "recovery or improvement in function and, when possible, restoration to a previous level of health and well-being.".

Who is required to sign a Medicare plan of care?

Medicare states that certification of the plan of care requires a dated signature on the plan of care, or some other document, by the physician or non-physician practitioner who is the primary care provider for the patient.

Who establishes a plan of care?

The plan of care is established by a physician, non-physician practitioner, physical therapist, an occupational therapist, or a speech-language pathologist. Note: Chiropractors and Dentists may not refer patient for therapy services nor certify therapy plans of care. The signature and professional identity of the person who established the plan ...

How long is a delayed NPP certification good for?

Certifications are acceptable without justification for 30 days after they are due. Delayed certification should include one or more certifications or recertification's on a single signed and dated document.”

Does mandatory assignment apply to therapy?

The mandatory assignment provision does not apply to therapy services furnished by a physician/NPP or "incident to" a physician's/NPP’s service. However, when these services are not furnished on an assignment-related basis; the limiting charge applies.

How long do you have to recertify a patient?

If this occurs, you'll need to obtain a recertification from the physician. And no matter what, you must obtain a recertification after 90 days. So, to answer your first question, no—there is no rule that you must send the patient back to the referring physician after 10 visits.

How long does it take for Medicare to recertify?

And even when things do go according to plan, Medicare requires recertification after 90 days of treatment. If you’re a WebPT Member, you can use WebPT’s Plan of Care Report to identify which plans of care are still pending certification as well as which ones require certification—before those 90 days are up.

What is a POC in therapy?

The Plan of Care (POC) Based on the assessment, the therapist then must create a POC —complete with treatment details, the estimated treatment time frame, and the anticipated results of treatment. At minimum, Medicare requires the POC to include: Medical diagnosis. Long-term functional goals.

How long does it take for Medicare to discharge a patient?

Medicare automatically discharges patients 60 days after the last visit. Unfortunately, if the patient has been discharged, then you will need to perform a new initial evaluation. If you do not live in a direct access state, then you will also need to to get the physician's signature on the patient's new POC.

What is the evaluation of a licensed therapist?

Before starting treatment, the licensed therapist must complete an initial evaluation of the patient, which includes: Objective observation (e.g., identified impairments and their severity or complexity) And, of course, all of this should be accounted for you in your documentation.

How often do you need a progress note for Medicare?

Currently, Medicare only requires a progress note be completed, at minimum, on every 10th visit. I hope that helps!

What is a progress note for a therapist?

In it, the therapist must: Include an evaluation of the patient’s progress toward current goals. Make a professional judgment about continued care.

What is the purpose of Part B documentation?

From Medicare’s perspective, the primary purpose of all Part B documentation is to demonstrate that the care fully supports the medical necessity of the services provided. That means a Progress Report must clearly describe how the services are medically necessary for that patient.

Can progress reports be billed separately?

It’s also important to remember the time involved in writing a progress report cannot be billed separately. Like all documentation, Medicare considers it included in the payment for the treatment time charge. Progress Reports do not need to be a separate document from a daily treatment note.

Is rehabilitation therapy reasonable?

If an individual’s expected rehabilitation potential is insignificant in relation to the extent and duration of therapy services required to achieve such potential, rehabilitative therapy is not reasonable and necessary.”. In terms of rehabilitative therapy the terms improvement, expectation, reasonable and predictable period ...

How often do you need to recertify a POC?

Sign the recertification, documenting the need for continued or modified therapy whenever a significant POC modification becomes evident or at least every 90 days after the treatment starts. Complete recertification sooner when the duration of the plan is less than 90 days, unless a certification delay occurs. CMS allows delayed certification when the physician/NPP completes certification and includes a delay reason. CMS accepts certifications without justification up to 30 days after the due date. Recertification is timely when dated during the duration of the initial POC or within 90 calendar days of the initial treatment under that plan, whichever is less.

How long does a POC last?

The physician’s/NPP’s signature and date on a correctly written POC (with or without an order) satisfies the certification requirement for the duration of the POC or 90 calendar days from the date of the initial treatment, whichever is less. Include the initial evaluation indicating the treatment need in the POC.

What is a POC in rehabilitation?

Outpatient rehabilitation therapy services must relate directly and specifically to a written treatment plan (also known as the POC). You must establish the treatment plan/POC before treatment begins, with some exceptions. CMS considers the treatment plan/POC established when it is developed (written or dictated) by a PT, an OT, an SLP, a physician, or an NPP. Only a physician may establish a POC in a Comprehensive Outpatient Rehabilitation Facility (CORF).

How long does a HCPCS code have to be in a day?

CMS requires that when you provide only one 15-minute timed HCPCS code in a day, that you do not bill that service if performed for less than 8 minutes. When providing more than one unit of service, the initial and subsequent service must each total at least 15 minutes, and the last unit may count as a full unit of service if it includes at least 8 minutes of additional services. Do not count all treatment minutes in a day to one HCPCS code if more than 15 minutes of one or more other codes are furnished.

Plan of Care Requirements

See more on ptbillingservices.com

What Is A Plan of Care

Documentation to Review

Plan of Care References