Guest guest Posted June 6, 2006 Report Share Posted June 6, 2006 I am currently working with a medicare patient in an outpatient setting that I see one time monthly. Does my patient have to go back to her doctor every month to certify our monthly visit? This seems excessive and costly for one visit every 30 days after the 60th day from the initial evaluation. I underlined the Medicare rule below. Can anyone help make a suggestion? Thanks. Josh Kernen, PT C.H. Physical Therapy Portland, OR 220.3.2 - Outpatient Must be Under Care of Physician B3-2206.2, A3-3148.2, HO-242.2 Outpatient physical therapy, occupational therapy, or speech-language pathology services must be furnished to an individual who is under the care of a physician or non-physician practitioner who certifies the patient’s outpatient therapy services. If the therapy service continues past the 60th day, there must be evidence in the patient’s clinical record, which is a part of the therapy documentation, that a physician or non-physician practitioner has seen him/her within 60 days after the therapy began and every 30 days past the 60th day. If the requirement is not met, the therapy services are not covered (reasonable and necessary). The 60-day period begins with the therapist or pathologist initial encounter with the patient, i.e., the day when the evaluation is performed. In the event that an evaluation is not indicated the first treatment session begins the 60-day period. The therapist’s or pathologist’s first encounter with the patient should occur in a timely manner from the date of the physician’s therapy referral. For continuity of care the physician or non-physician practitioner who certifies the patient’s need for outpatient therapy services is the same person who meets the visit requirements. In addition, timing of recertifications and the visit requirements should coincide. However, the physician or non-physician practitioner still makes the necessary certifications --------------------------------- How low will we go? Check out Yahoo! Messenger’s low PC-to-Phone call rates. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 6, 2006 Report Share Posted June 6, 2006 Josh, This changed one year ago today. CMS eliminated the physician office visit unless the physician/NPP requires it or the patient is receiving e-stim for wound care or electromagnetic stim for wound care. Here is the link to the manual: http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf Read section 220.1.3 C on page 128-129. Rick Gawenda, PT Director PM & R Detroit Receiving Hospital Gawenda Seminars www.gawendaseminars.com --- Josh Kernen wrote: > I am currently working with a medicare patient in an > outpatient setting that I see one time monthly. > Does my patient have to go back to her doctor every > month to certify our monthly visit? This seems > excessive and costly for one visit every 30 days > after the 60th day from the initial evaluation. I > underlined the Medicare rule below. Can anyone help > make a suggestion? Thanks. > > Josh Kernen, PT > C.H. Physical Therapy > Portland, OR > > 220.3.2 - Outpatient Must be Under Care of > Physician > B3-2206.2, A3-3148.2, HO-242.2 > Outpatient physical therapy, occupational therapy, > or speech-language pathology services must be > furnished to an individual who is under the care of > a physician or non-physician practitioner who > certifies the patient’s outpatient therapy services. > If the therapy service continues past the 60th day, > there must be evidence in the patient’s clinical > record, which is a part of the therapy > documentation, that a physician or non-physician > practitioner has seen him/her within 60 days after > the therapy began and every 30 days past the 60th > day. If the requirement is not met, the therapy > services are not covered (reasonable and necessary). > The 60-day period begins with the therapist or > pathologist initial encounter with the patient, > i.e., the day when the evaluation is performed. In > the event that an evaluation is not indicated the > first treatment session begins the 60-day period. > The therapist’s or pathologist’s first encounter > with the patient should occur in a timely manner > from the date of the physician’s therapy referral. > For continuity of care the physician or > non-physician practitioner who certifies the > patient’s need for outpatient therapy services is > the same person who meets the visit requirements. In > addition, timing of recertifications and the visit > requirements should coincide. However, the physician > or non-physician practitioner still makes the > necessary certifications > > > > > > > --------------------------------- > How low will we go? Check out Yahoo! Messenger’s low > PC-to-Phone call rates. > > [Non-text portions of this message have been > removed] > > > > > __________________________________________________ Quote Link to comment Share on other sites More sharing options...
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