Delayed Certification under Medicare Part B Therapy Services

April 24, 2017
Rick Gawenda

I have been receiving an increase in emails asking about the certification and recertifcation process for Medicare beneficiaries receiving outpatient therapy services. This is due to Strategic Health Solutions, the supplemental medical review contractor who is auditing claims that exceeded $3700 in a calendar year, denying many claims and citing the reason as the physician did not certify (sign and date) the plan of care in a timely manner.

Under Medicare Part B therapy services, the initial certification is considered timely if the physician or non-physician practitioner (NPP) signs and dates the plan of care within

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