Do Therapy Orders & Notes Need to be Timed for Medicare Patients

October 16, 2017
Rick Gawenda

Do therapy orders for Medicare Part B patients referred to outpatient therapy need to be timed by the physician who is ordering the therapy? Do signed plans of care need to be timed by the physician? In addition, do notes written by a therapist or an assistant have to be timed as well as dated? The answer depends on your practice setting.

If you are providing outpatient therapy in a hospital outpatient therapy department or clinic, the Conditions of

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  1. Wen you say timed, are you referring to time in/out or the time stamp of when the documentation was completed?

  2. If you have an assessment and proceed directly into treatment, do they need distinct in/out times or one in/out with clear documentation to demonstrate both and assessment and treatment were provide?

    1. Documentation would need to support your billing for the evaluation and treatment. CMS requires you document total timed minutes and total treatment time.

  3. According to Medicare, we (PT) do not need an order to see a patient with medicare. We only need the POC signed. If the above statement is true, why does CMS want us to get orders time stamped? Thanks, Mark Randell

    1. You need to look at the Conditions of Participation for your practice setting and follow those rules and regulations.