What Must I Do When a Patient Becomes Medicare During an Outpatient Therapy Episode of Care?
Lately, I have been receiving questions what a therapist must do when an active outpatient therapy patient becomes Medicare eligible during an episode of care. In this article, I will answer the following questions:
- When an outpatient therapy patient becomes Medicare eligible during an episode of care, must I perform another evaluation or a reevaluation?
- When an outpatient therapy patient becomes Medicare eligible during an episode of care, when would I establish the plan of care and have it certified by their physician or non-physician practitioner (NPP)?
- When an outpatient therapy patient becomes Medicare eligible during an episode of care, do I need a new order from the patient’s physician?
- When an outpatient therapy patient becomes Medicare eligible during an episode of care, when would the Progress Report period begin?
- What is the difference between Medicare Part A and Medicare Part B?
- When does Medicare Part A and B coverage begin?
- How can I determine if Medicare is the primary or secondary insurance for a Medicare beneficiary?
- Do therapy visits that occurred before the beneficiary become Medicare eligible count towards the annual therapy dollar threshold amount?
Let’s begin!
Question
When an outpatient therapy patient becomes Medicare eligible during an episode of care, must I perform another evaluation or a reevaluation?
Answer
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Question
When an outpatient therapy patient becomes Medicare eligible during an episode of care, when would I establish the plan of care and have it certified by their physician or NPP?
Answer
The content here is for members only log in here or sign up.
Question
When an outpatient therapy patient becomes Medicare eligible during an episode of care, do I need a new order from the patient’s physician?
Answer
The content here is for members only log in here or sign up.
Question
When an outpatient therapy patient becomes Medicare eligible during an episode of care, when would the Progress Report period begin?
Answer
The content here is for members only log in here or sign up.
Question
What is the difference between Medicare Part A and Medicare Part B?
Answer
The content here is for members only log in here or sign up.
Question
When does Medicare Part A and B coverage begin?
Answer
The content here is for members only log in here or sign up.
Question
How can I determine if Medicare is the primary or secondary insurance for a Medicare beneficiary?
Answer
The content here is for members only log in here or sign up.
Question
Do therapy visits that occurred before the beneficiary become Medicare eligible count towards the annual therapy dollar threshold amount?
Answer
The content here is for members only log in here or sign up.
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All material posted on our website is the intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without the prior written approval of Gawenda Seminars & Consulting, Inc.
This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.
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Question: If a eval/re-eval is not necessary during change in coverage and only a certified POC, if on the date of service bill only the procedure codes that occurred that day (ie manual; therex, etc) are billed, is there a risk for a denial as CMS would not have an evaluation CPT code to reference. The reason I ask this question is that we have had commercial plans have denied claims if an eval code was not submitted during a commercial plan to commercial plan change-
In the CMS manuals, CMS does not state an evaluation must be billed first.