Delayed Certification under Medicare Part B Therapy Services
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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great summary . Thankyou
You are welcome! Glad you enjoyed the article.
Thank you for all your help Rick!
Steve Ryland PT, DPT
You are welcome!
Awesome, useful information, as usual! Not to mention, a reminder to myself to make sure our practice is maintaining compliance.
Thank so much for keeping your Gold Members up to date on all things that matter!
Thank you for taking the time to write the kind words! They are greatly appreciated! Michelle and I also appreciate all of our Gold Members and those of you that attend our webinars, seminars and use our consulting services. Thank you very much for your loyalty and putting your trust in us!
During a recent audit by Medicare, we were told by the auditor that we were required to have the plan of care signed within 30 days of the prescription, not evaluation date. Was this information correct? We have been going by the evaluation date.
The information from the auditor was incorrect. The exact language from CMS is “Certifications are timely when the initial certification (or certification of a significantly modified plan of care) is dated within 30 calendar days of the initial treatment under that plan.”