Home Health & Hospice

More on Non-Coverage of Therapy Visits

Homecare Insider, July 4, 2011

Non-coverage of therapy visits related to the new requirements continues to cause confusion to providers. Let’s take a look at one scenario that was recently clarified: non-coverage of therapy visits, in the case of multiple therapy disciplines being provided.

Therapy visits will not be covered until all qualified therapists (from each discipline providing care) have completed their reassessments. The National Association of Home Care and Hospice posed this example to the Centers for Medicare and Medicaid Services (CMS):

Physical therapy and occupational therapy are both providing care and are going to provide more than 13 visits. Physical therapy completes their reassessment visit on visit 12, but occupational therapy does not complete their reassessment until visit 17. What visits would be covered?

CMS stated that visits 14, 15, 16, are not covered. Once occupational therapy completes their reassessment, coverage resumes. However, coverage does not resume until the visit following the reassessment visit.

Considering this, agencies should ensure that reassessments are completed timely, according to the requirements. If not, it will result in non-coverage of therapy visits until after they are completed. Careful tracking of reassessment due dates and dates completed is required to ensure compliance. Agencies may want to consider holding therapists accountable for this tracking and utilizing a checklist to enable them to do so.

Read CMS’ Q&As regarding the therapy requirements here.