FAQ – Certifications & Recertifications

Question

Must the physician who ordered the outpatient therapy be the same physician to certify and/or recertify the plan of care?

Answer

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Question

Must a Medicare beneficiary have a face-to-face visit with their physician before beginning outpatient therapy services?

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Question

What would be some examples of an insignificant change that would not require the therapist to do an updated plan of care?

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Question

What would be an example of a significant change that would require the therapist to do an updated plan of care?

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Question

What are optional items that I can include in a plan of care for a Medicare beneficiary receiving outpatient therapy services?

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Question

What are the required elements for a plan of care for a Medicare beneficiary receiving outpatient therapy services?

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Question

Does the Medicare program require a physician order for outpatient therapy services to be paid?

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Question

How long is a certification and recertification valid for under Medicare Part B outpatient therapy services?

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Question

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?

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Question

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?

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Question

Who can sign a plan of care certifying and recertifying for outpatient therapy services under the Medicare program?

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Question

What is delayed certification and recertification?

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Question

What are some possible justifications to support delayed certification or recertification?

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Question

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?

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