RE: Medicare 30 day rule

August 13, 2004

I have a question regarding reevals also. Our PT biller went to a seminar

yesterday where she was told that 97002 is not covered by Medicare and

should not be billed to that payor. We can't find verification of this. Can

anyone help clarify?

Vicki Saunders

Practice Administrator

Mays and Schnapp Pain Clinic and Rehabilitation Center

Medicare 30 day rule

Hello all,

My supervisor has asked me to post the following question (any documentation

you can refer us to would be great):

How is the following situation handled?

The 30 day reassessment date (from date of eval) is for example, August 11,

but the PT (due to scheduling problems, vacation, etc. ) cannot reevaluate

the patient say until August 13.

Can the patient be seen for treatment on Aug 12 (by a PTA) or do they have

to lose treatment time until the reassesment actually takes place?

My review of Transmittal 5 (January 2004), 220.3.1 (Physician's

Certification and Recertification), Section D (Delayed Certification) shows:

" Delayed certifications and recertifications are to include an explanation

for the delay and any other evidence the clinic considers necessary in the

case. The format of delayed certifications and recertifications and the

method by which they are obtained is left to the individual facility and/or

practitioner. "

Does anyone have experience with documenting similar reasons for delayed

recert's?

Thanks for any help!

Lorraine Tyner, MPT

Phila, PA

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August 13, 2004

Lorraine,

During my work in a SNF, where pt's had to be recertified every 30

days, each facility handled it a little differently. Sometimes the

facility would require that all patients be recertified at the beginning

of every month (a real pain for those pt's evaluated at the end of the

month), while others required recert 30 days following eval. On

occasion, if I knew that the recert fell during a time when I knew that

it couldn't be completed (Sunday for example), I would simply complete

the recertification early. To my knowledge there isn't a penalty for

doing so. In my opinion, it's better to get it done early than to have

it be late. I don't believe that any treatment can be provided after

the certification period has lapsed. I wish that I could steer you in

the direction of supportive documentation regarding what I've told you,

but what I've shared is based on how our company handled situations

similar to what you mentioned.

Thanks,

Curtis Marti, OTR/L

August 13, 2004

In hindsight when we know this situation is going to occur due to a

vacation, staffing issue etc. we go ahead and complete the re-certification

early. If it occurs due to unexpected event (i.e. illness), the re-cert

itself is completed and dated the day the therapist completes it, however,

the recertification dates on the 701 still represent the original re-cert

period for physician signature. Once again this is the clarification we

have received from our local FI.

As for treatment, if you have a physician order for treatment on a daily

basis I would not skip the treatment due to state compliance issues with

following physician orders. The completion of the 701/or 30 day

re-certification really is indicative of reimbursement for services not

actually limiting the delivery of services under our state practice act.