I receive many questions regarding certifications and recertifications for Part B therapy services. Some of the most common questions I receive are the following: How long is a certification and recertification valid for under Medicare Part B outpatient therapy services? How soon must a plan of care be signed by a physician or NPP to be considered timely under Medicare Part B rules and regulations? Who can sign a plan of care certifying and recertifying for outpatient therapy services under the Medicare program? What is delayed certification and recertification? What are some possible justifications to support delayed certification or recertification?

Private practices and facilities (skilled nursing facilities, rehab agencies and hospitals) are reporting difficulty getting paid for outpatient therapy claims with Humana’s commercial and Medicare Advantage insurance plans. The American Physical Therapy Association (APTA) has received many complaints from their members regarding the retroactive application of the multiple procedure payment reduction (MPPR), further reductions to in-network providers’ rates through the MPPR, confusion around Humana’s approach to anatomical modifiers, and inconsistent application of the 59 modifier, with denials occurring even when the modifier was visible on the claim. APTA staff have been in discussion with a representative from Humana to facilitate a