Common Outpatient Rehabilitation Therapy CERT Errors

1. Common Outpatient Rehabilitation Therapy CERT Errors Medical Billers and Coders

2. Billing Part B Outpatient Therapy Services • Outpatient rehabilitation therapy includes Physical Therapy (PT), Occupational Therapy (OT), and Speech-Language Pathology (SLP) services. Medicare covers outpatient PT, OT, and SLP services when: • A physician or Non-Physician Practitioner (NPP) certifies the “treatment plan,” called the Plan of Care (POC), ensuring: • A patient needs therapy services  • POC is:  • Established by a physician, NPP, our qualified therapist provides services  • Reviewed periodically by a physician or NPP • A patient gets services under physician care  • POC certifying the provider’s name and NPI is on the claim  • Providers meet medical necessity, documentation, and coding requirementsh

3. Where,  • CERT: Comprehensive Error Rate Testing • A physician is a Doctor of Medicine, osteopathy, podiatric medicine, and optometry (only for low vision rehabilitation).  • NPP includes a Physician Assistant (PA), Clinical Nurse Specialist (CNS), or Nurse Practitioner (NP).  • A qualified Therapist includes a PT, OT, or SLP who meets regulatory qualifications as applicable, including state licensure or certification.

4. Common Outpatient Rehabilitation Therapy CERT Errors 1. Missing Certification and Recertification 2. Missing Signature 3. Missing or Incomplete POC 4. Missing Significant POC Changes 5. Missing Total Time 6. Missing or Incomplete Initial Evaluation 7. Missing or Incomplete Progress Reports 8. Missing Elements Supporting Medical Necessity

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