Documentation Tip: An Essential Element for Physical Therapy Claims
Physical therapy has made it in the Office of Inspector General’s (OIG’s) work plan for several years running. With medical reviewers on the lookout for high utilization of outpatient physical therapy services, coders and billers need to be vigilant about how their physical therapists are documenting services.
Per Chapter 15, Section 220.1.1 of the Medicare Benefit Policy Manual, payment for physical therapy is dependent on the certification of the plan of care for the patient receiving services. A signed and dated order is acceptable as certification if it meets the requirements of the plan of care.
A valid plan of care for physical therapy, occupational therapy, or speech-language pathology services prescribes the:
- Frequency, and
- Duration of services.
A diagnosis and anticipated goals that are consistent with the patient function reporting on claims for services must also be in the plan of care.
Bottom line: Medicare Part B only pays for therapy services if a physician, or other non-physician practitioner with knowledge of the case, signs and dates the care plan as soon as possible (within 30 days of the initial therapy treatment). Without this information, claims will be denied due to insufficient documentation.
Source: Medicare Learning Network, Medicare Quarterly Provider Compliance Newsletter: Guidance to Address Billing Errors, Volume 5, Issue 1, October 2014