Rehab

Manual changes good news for rehab

Rehab Regs, June 15, 2005

On May 6, CMS released Transmit tal 34, which contains revisions to the Medicare Benefit Policy Manual (Pub. 100-02), Chapter 15, Sections 220-230.6, and loosens many of the current requirements related to physician orders, visits, and certifications.

Changes to the manual, which took effect June 6, include the following:

Physician visit --CMS previously required Medicare beneficiaries to see a physician within 60 days of beginning therapy and every 30 days thereafter to continue therapy services. These changes eliminate that policy.

"The physician still needs to recertify the patient every 30 calendar days, but the patient doesn't need to physically go see the doctor," says Rick Gawenda, PT, director of rehabilitation for Detroit Receiving Hospital. "Now visits with the physician aren't required unless the physician requests a visit, or if the patient receives electrical stimulation or electromagnetic stimulation for wound care."

Physician orders --Medicare does not require physician orders for therapy services, although it is often helpful to obtain an order to show that the physician is involved in the patient's ongoing treatment and available to certify the plan of care (POC).

"There has always been tremendous confusion because the certification has been thought to be different from the plan of care, the referral, and the prescription," says Ken Mailly, PT, of Mailly and Inglett Consulting, LLC, in Wayne, NJ.

"This is a statement that essentially says, 'Have the physician sign your plan [of care] and it serves all purposes.' "

POC --The POC must now only contain diagnoses, long-term treatment goals, and the type, amount, duration, and frequency of therapy services, according to CMS.

Changes to the POC --Prior to this transmittal, a physician needed to recertify the POC when you made changes to it. Now, this only needs to occur for significant alterations. CMS cites an example as changes to long-term goals.

Changes to the POC that would not require a physician's recertification include a decrease in frequency and duration, or modification of short-term goals.

Initial certification of plan --CMS had required that therapists obtain signatures for initial certification for POCs "as soon as possible." The transmittal now defines this phrase as within the first 30 days of the first encounter with the patient. For example, if the patient starts therapy on July 1, the POC must be certified by a physician, nurse practitioner, clinical nurse specialist, or physician assistant, where allowed by state law, by July 31.

Transmittal 34 also allows a therapist to accept a verbal order to certify or recertify a POC. If this occurs, the therapist must obtain the necessary signature for the verbal order to certify or recertify within 14 days by the professional who gave the verbal order.

Delayed certification --If the POC is not certified or recertified by the physician within the 30-day period but is certified or recertified between days 31 and 60, you can still submit a delayed certification without justification for why the certification/recertification was delayed. If the POC is certified/recertified on day 61 or after, the provider will need to include a reason for the delay.

"[After] the 60 days, you can submit justification, and [the certification] may still be accepted," says Gawenda. "You have a little more flexibility, now."

Although these changes are positive for the therapy industry, Mailly cautions that, regardless of what CMS now allows, make certain it is permissible in your state first.

"If your state says you can't do something, it's irrelevant what Medicare regulations say," says Mailly. "This transmittal puts an even greater emphasis on understanding state level laws and regulations."

Editor's note: Visit www.cms.hhs.gov/manuals/pm_ trans/R34BP.pdf to read the transmittal. Also visit www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3648.pdf to read a provider education article issued by CMS.

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