RE: Physician Recertification on the Plan of Care

[Guest guest]

I have read the new requirement on recertifying a patient's plan of care every

30 days and am having difficulty understanding what, if anything changed. I do

see a subtle shift, but I was expecting to see a major one. Anyone care to

clarify this for me???

Here is what I read:

http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3648.pdf

Jim Hall, CPA <///><

General Manager

Rehab Management Services, LLC

Cedar Rapids, IA

319/447-5625

Visit our website at:

http://rehabmgmt.com

[Guest guest]

I have read the new requirement on recertifying a patient's plan of care every

30 days and am having difficulty understanding what, if anything changed. I do

see a subtle shift, but I was expecting to see a major one. Anyone care to

clarify this for me???

Here is what I read:

http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3648.pdf

Jim Hall, CPA <///><

General Manager

Rehab Management Services, LLC

Cedar Rapids, IA

319/447-5625

Visit our website at:

http://rehabmgmt.com

[Guest guest]

I have read the new requirement on recertifying a patient's plan of care every

30 days and am having difficulty understanding what, if anything changed. I do

see a subtle shift, but I was expecting to see a major one. Anyone care to

clarify this for me???

Here is what I read:

http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3648.pdf

Jim Hall, CPA <///><

General Manager

Rehab Management Services, LLC

Cedar Rapids, IA

319/447-5625

Visit our website at:

http://rehabmgmt.com

[Guest guest]

Here's what I understood. Originally POC's had to be recertfied every 30

days, then this past year or so, at some point medicare allowed the pt to be for

PT initially for 60 days before getting a recert.and visiting the Dr. Now I

understand it's back to 30 days, although the Dr. signing the POC has 30 days to

get it back to you, but you have to do the recert/POC every 30 days,vs 60

days, then every 30...I think that's correct.

Amy

[Guest guest]

Here's what I understood. Originally POC's had to be recertfied every 30

days, then this past year or so, at some point medicare allowed the pt to be for

PT initially for 60 days before getting a recert.and visiting the Dr. Now I

understand it's back to 30 days, although the Dr. signing the POC has 30 days to

get it back to you, but you have to do the recert/POC every 30 days,vs 60

days, then every 30...I think that's correct.

Amy

[Guest guest]

Here's what I understood. Originally POC's had to be recertfied every 30

days, then this past year or so, at some point medicare allowed the pt to be for

PT initially for 60 days before getting a recert.and visiting the Dr. Now I

understand it's back to 30 days, although the Dr. signing the POC has 30 days to

get it back to you, but you have to do the recert/POC every 30 days,vs 60

days, then every 30...I think that's correct.

Amy

[Guest guest]

Hi Jim:

I agree that the recert changes are subtle: The new information clarifies

that failure to certify will get only a technical denial and can be appealed

and reversed even as much as 2 years late! Also, there is much more

flexibility in the timing of the cert: Some FI's have required it early in

the episode of care; this clarification allows it any time in the 30 day

period (or even later it appears)

The bigger issue is the elimination of the visit requirement to the

physician.

Angie

Angie

President/CEO

Images & Associates

407 South Shore Drive

Amarillo, TX  79118

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www.ptconsultant.com

Home of The Desktop Consultant Series:  

The Rehab Department's Guide to JCAHO - 2005 Edition

The Book of Policies for Rehabilitation Services - Now Available

Email:  images@...

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Re: Physician Recertification on the Plan of Care

I have read the new requirement on recertifying a patient's plan of care

every 30 days and am having difficulty understanding what, if anything

changed. I do see a subtle shift, but I was expecting to see a major one.

Anyone care to clarify this for me???

Here is what I read:

http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3648.pdf

Jim Hall, CPA <///><

General Manager

Rehab Management Services, LLC

Cedar Rapids, IA

319/447-5625

Visit our website at:

http://rehabmgmt.com

[Guest guest]

This speaks to the timeliness of getting a signed POC. MC had a vague time

line on the POC signature and left it open for interpretation. This

essentially allows a 30 day window for POC signature in the absence of a

specific order.

Ron Barbato P.T.

Corporate Director , Rehabilitation

Ephraim McDowell Health

Voice (859 )239-1515

Fax (859 )936-7249

rbarbato@...

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Re: Physician Recertification on the Plan of Care

I have read the new requirement on recertifying a patient's plan of care

every 30 days and am having difficulty understanding what, if anything

changed. I do see a subtle shift, but I was expecting to see a major one.

Anyone care to clarify this for me???

Here is what I read:

http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3648.pdf

Jim Hall, CPA <///><

General Manager

Rehab Management Services, LLC

Cedar Rapids, IA

319/447-5625

Visit our website at:

http://rehabmgmt.com

[Guest guest]

Hi Jim,

Based on our review of the new Medicare Benefit Policy Manual, we feel the

guidelines have changed as follows:

A reminder that we are not Medicare experts

The biggest change in the certification process is that CMS is advising that

treatment can begin immediately whereas before carriers where interpreting

the Benefit Policy Manual as treatment could not begin until certification

was obtained. This was the bane of every therapist because it frequently

meant long delays in the start of care while waiting for a signed

certification to come back from the physician.

Now the Benefit Policy Manual section on certification is much more common

sense and allows treatment to get started right away.

They also spell out, finally, what to do in case certification is delayed

and they offer a process to go through if the certification is delayed.

This again protects the therapist's ability to continue treatment while

trying to get a signed certification on file.

The Benefit Policy Manual advises that certification must be obtained " as

soon as possible after the plan of care is established " and keep the 30 day

requirement that has always been there.

The other big change that you are aware of is that the Benefit Policy Manual

clears up the issue of referral stating that a physician (or non-physician

provider)'s referral is not needed to begin treatment. They do recommend

that a referral or order is on file to certify that the Medicare beneficiary

is under the care of a physician for the problem that the therapist is

treating (one of the established criteria that must be met to treat).

Hope this is what you needed.

Tom Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, ID

ptclinic@...

Re: Physician Recertification on the Plan of Care

I have read the new requirement on recertifying a patient's plan of care

every 30 days and am having difficulty understanding what, if anything

changed. I do see a subtle shift, but I was expecting to see a major one.

Anyone care to clarify this for me???

Here is what I read:

http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3648.pdf

Jim Hall, CPA <///><

General Manager

Rehab Management Services, LLC

Cedar Rapids, IA

319/447-5625

Visit our website at:

http://rehabmgmt.com