Reevaluations vs Progress Reports: What’s the Difference?

I often have therapists tell me that they have to do a reevaluation on all of their patient’s every 30 days from the date of the patient’s initial evaluation. I then ask them why they think that is a requirement. Their response is usually along the lines of “Medicare requires we do a reevaluation every 30 days” or “my state practice act requires we do a reevaluation every 30 days” or “my employer or my organization requires we do a reevaluation every 30 days.” In this article, I will address the above 3 responses and explain why it probably is not a reevaluation that you are doing, rather, is a Progress Report they are completing.

First of all, a reevaluation is not appropriate to bill on Medicare patient’s or for that matter, any other patient every 30 days from the start of care. The Medicare program does not require reevaluations be performed at certain intervals. I am also not aware of an insurance carrier that requires reevaluations be performed every 30 days. What the Medicare program does require as do some private insurance carriers is that the therapist complete a progress report every so often during the episode of care and I will address progress reports later in this article. In addition, a reevaluation is not appropriate to bill simply because your state practice act and/or your employer/organization requires a reevaluation every 30 days or other specific time frame.

A reevaluation may be considered reasonable and necessary in the following situations: