Using a Physician Order as the Initial Certification for Medicare

June 15, 2026
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Rick Gawenda
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Are you aware that you can use a physician order in lieu of a physician signing your initial plan of care? You didn’t? Don’t feel bad, you are not alone! Reviewers at your Medicare Administrative Contractor who are reviewing your outpatient therapy documentation are unaware as well.

When Did This Change Occur?

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What Was The Change?

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What Criteria Must be Met for an Order to Serve as a POC?

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Which Frequency and Duration Do I Use?

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What Outpatient Therapy Settings Does This Change Apply To?

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Where Can I Obtain Additional Information on this Topic?

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  1. Rick,
    Appreciate this clarification. I’m assuming this is only for “traditional” Medicare and not Medicare Advantage plans, unfortunately.

    Thanks

  2. Thanks for publishing this, Rick. We are actually in the middle of a TPE audit with WPS and they do not understand this rule change. We are going to battle for what we know is right and your information has been very helpful.

    1. You are welcome. The resource at the end of this article will be your clincher for the victory!