Medicare Plan of Care Changes for 2025
The Centers for Medicare and Medicaid Services (CMS) has finalized changes to the initial certification requirement for outpatient physical, occupational, and speech therapy services. In this article, I will answer the following questions:
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Hi Rick, if a Dr sends over order for therapy for 3x a week for 4 weeks but therapist would like to do initial POC for 3x a week for 6 weeks do we need to get a signature on that POC or will just sending it over count as certified?
Thanks!
You would follow the therapist established POC unless amended by the physician/NPP.
Hi, Are the Medicare Advantage plans that required a signed POC now following the new guidelines? United, Univera, Aetna, IHA and Wellcare?
Please read the answer to the question – Does this change apply to Medicare Advantage plans
Hi Rick,
Do we still have to send over the evaluation to the referring provider? Is the only thing that is changing is that we do not need the initial POC signed?
Please read the answer to the first question regarding what must be sent to the physician.
I appreciate your help. So if the original Medicare plan of care is for PT 2 times per week for 6-8 weeks, would a recertification need to be completed at the 8 week mark or the 90 days? And that recertification would require a Physician signature? Thank you.
I would not use ranges. If you said the duration was for 8 weeks in your POC, then you would need a recertification after 8 weeks.