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Medicare Part B Certifications and Recertifications

by • July 2, 2018 • 17 Comments

I receive many questions regarding Medicare Part B certifications and recertifications as they pertain to outpatient physical, occupational and speech therapy services. In this article, I will answer the following questions:

1. How long is a certification and recertification valid for under Medicare Part B outpatient therapy services?
2. 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?
3. What is delayed certification and recertification? 
4. What are some possible justifications to support delayed certification or recertification?
5. If I only do an evaluation on a Medicare beneficiary under Part B and discharge them as they do not required continued
therapy, must I have the plan of care signed and dated by the physician/non-physician practitioner?
6. If I evaluate and treat a Medicare beneficiary in the emergency department or while under observation status and they do not
get admitted to the hospital (i.e. they get discharged home), must I have the plan of care signed and dated by the physician?
In addition, check out my 2 recent articles on who can certify and recertify for outpatient therapy services. Click HERE to read about dentists and chiropractors certifying and recertifying an outpatient therapy plan of care. Click HERE to see the full list of who can certify and recertify for outpatient therapy services.
Lets begin!
Question #1:
How long is a certification and recertification valid for under Medicare Part B outpatient therapy services?
Answer:

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17 thoughts on “Medicare Part B Certifications and Recertifications”

  1. Jill LaRock says:

    A few years ago I read something that said you must try to get the certification signed by the provider for 2 years before you do not get the signature. Looking for validation on this. We currently save all fax confirmations and document all phone calls when trying to get the certification or recertification signed but if we are not able to obtain this within 2 years then we stop trying at that time. Any help on this question. Thank you.

    1. Rick Gawenda says:

      You can check out more of my FAQs on certifications and recertifications at https://gawendaseminars.com/faqs/certifications-recertifications/

  2. Dawna Bell says:

    Are there any differences, regarding the time frame of the physician’s signature on the plan of care, between professional and institutional?

    1. Rick Gawenda says:

      No!

  3. Matt Sturgis says:

    If a medial director signs the POT vs the referring MD will that work

    1. Rick Gawenda says:

      Check out my latest FAQ answering this question.
      https://gawendaseminars.com/faqs/certifications-recertifications/

  4. Erin Vredeveld says:

    If the Dr signs a POC for example 2x/week for 5 weeks, what happens if the patient misses a week or 2 due to vacation or illness?

    1. Rick Gawenda says:

      If you stated a duration of 5 weeks, a Medicare contractor could state you would need a recertification after 5 weeks even if the patient did not have their 10 visits yet ( 2 times per week times 5 weeks).

  5. Yvonne Coombs says:

    How long is an initial doctor’s signed prescription good for? If a patient is unavailable to be seen for a few weeks and finally calls to schedule but the signed order is from 6 weeks ago, is that prescription still valid? Or do we need to get a fresh signed order from the MD?

    1. Rick Gawenda says:

      If there are any restrictions on how long a physician order is valid for, you would need to check your state practice act. state Administrative rules and with the insurance carrier.

  6. Ron Ryskalczyk says:

    How far back in time can one bill Medicare for PT or OT services?

    1. Rick Gawenda says:

      One year from date of service.

  7. Loren Simpson says:

    what if the ordering physician is no longer in practice, and there is no one to sign the POC?

    1. Rick Gawenda says:

      Then you can’t bill Medicare for those services.

  8. Erin Vredeveld says:

    In a recent e-mail from CMS MLN Connects there was a link for a new publication called “Medicare Billing for Outpatient Physical Therapy Fact Sheet — New” and on page 3 it states “Medicare Part B regulations require all covered outpatient PT services be: Certified by a physician or NPP (the provider must sign the POC before treatment starts, except
    for the time allowed for transcription)”

    Am I reading this correctly that the PT cannot provide any additional treatment until the POC has in fact been signed? This just doesn’t sound right, can you please provide further explanation on this? And if it is correct, would having a referral/RX from a physician or NPP suffice?

    1. Rick Gawenda says:

      That publication contained many errors and APTA has notified CMS of the errors. I recommend you read and reference CMS Publication 100-02, Chapter 15, Section 220.1.1 – 220.1.3 for the requirements for a plan of care and certification/recertification requirements and timely signatures.

      1. Erin Vredeveld says:

        Thank you this makes so much more sense 🙂

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