Progress Reports vs Recertifications: What’s the Difference?

May 16, 2016
Rick Gawenda

Two weeks ago, I discussed the difference between a reevaluation and a progress report that is applicable to all insurance carriers, including the Medicare program. To read that article, click HERE. Last week, I discussed what the required elements are for a progress report. To read that article, click HERE. This week, I will discuss the difference between a progress report and a recertification for Medicare Part B patients.

Under Medicare Part B, the Centers for Medicare and Medicaid Services (CMS) states the minimum progress reporting period shall be at least once every

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  1. When creating and editing goals, is there a preference or requirement of whether to use a number of visits the goal is to be met by or an actual date?

  2. Hi Rick.
    I enjoyed reading your article stating “minimum progress reporting period at least once every 10 treatment sessions.” Has Medicare eliminated the every 30 chronological days requirement if that comes sooner than the 10 treatment sessions?

  3. Is the PT still required to get at least 1 billable unit every 10 visits (progress note period) for Medicare?

  4. Since a progress note is required once every 10 visits, does that mean that every visit in between can be performed by a PTA? The only documentation I can find on this matter is the APTA’s document on Direction and Supervision of PTAs which states a supervisory visit must be performed by the PT every 30 days.

    1. Per Medicare, yes; however, you must also read and know your practice act and how often does a therapist need to see the patient and/or be involved in their care.

  5. If a progress note is being used for a re-certification, does the note title need to state it is a re-certification? Or as long as the progress note has the required re-certification sections and physician signature that is sufficient?