Eli's Rehab Report

Published on Wed May 19, 2010 PDF

Question: I need some clarification on Part A Medicare re-certifications in a skilled nursing facility. I've been getting conflicting opinions. My trusted colleagues and professional consultants have always told me that a re-certification was not necessary until the initial certification period was complete. For example, a patient may have goals and a plan of care set for a six-week period then get a re-certification at the end of the six  weeks if therapy needs to continue. I recently heard, however, during a national continuing education course, that Medicare Part A certifications need to be completed every 30 days. Do you have any thoughts that might clarify these discrepancies?

-- Massachusetts subscriber

Answer: When you say Medicare Part A, are you referring to therapy reimbursed under PPS in the SNF setting? If that is the case, the physician must recertify all services the resident requires within 14 days of admission and then every 30 days thereafter. Medicare policy does not mandate that therapy complete separate certifications and re-certifications.

Many skilled nursing facilities have therapists develop a separate plan of care for Part A patients that the physician then signs to ensure that the plan of care contains all required elements that may have been left out in the plan of care that the physician developed.

If, however, you're referring to outpatient therapy provided in the SNF setting reimbursed under Medicare Part B benefits, that's a different story. In such situations, a physician must sign the initial certification which is valid for the duration of the plan of care (that the therapist established and the physician signed) or 90 days from the start of care, whichever is less.