Medicare Compliance & Reimbursement

Experts explain how therapists can take advantage of the new rule change.

Obtaining physician certifications and recerts for therapy patients is enough to drive some therapists certifiably mad.
 
Getting patients in to see their physician, and getting the physician to sign and return the appropriate paperwork, has long been a nightmare for therapy providers. But it's a nightmare providers must endure, because without a physician's certification, they won't get paid for the treatment they provide, reminds consultant Fran Fowler with Fowler Healthcare Affiliates in Atlanta.
 
Historically, therapy patients had to visit their physician within 30 days of beginning outpatient therapy, and then had to be recertified by the physician for continued therapy every 30 days thereafter. But thanks to new policies set out in a recent transmittal from the Centers for Medicare & Medicaid Services, patients now can wait 60 days after starting therapy before visiting their physician, notes Michael Matlack, assistant director of grassroots and political affairs with the American Physical Therapy Association.
 
Another change outlined in the transmittal: Non-physician practitioners now are able to certify a plan of care. Further, the rules now apply across the board to PTs, OTs and SLPs.
 
Even though there now is more breathing room between the start of the therapy and the patient's first encounter with the physician, therapists still must obtain recerts every 30 days thereafter, as has always been the case.

Follow These Recert Tips To Ensure Success

Mistake: The single biggest mistake rehab providers make that keeps those precious recerts from coming back on time is that they make it too hard for the physician to digest the information on the recert form, insists Fowler.
 
Solution: Since insurance companies require gobs of information on the recert form, therapists can't do much about making it easier to swallow. However, they can provide a short summary of the patient's situation for the physician as a cover to that form, Fowler offers. The doctor is far more likely to respond quickly to a paragraph or two than he is to a dense form, she says. Therapists should "give them the information in sound bites," Fowler quips.
 
Avoid this money pit: Rehab providers "don't want someone who's being paid $30 an hour on the phone chasing signatures," points out Rick Gawenda, director of rehab services for Detroit Receiving Hospital in Detroit. This task should instead go to your front office/clerical staff members.
 
Not only will this save therapists' valuable time, but it will likely garner better results, Gawenda says. Front office staff members work well together because they understand the challenges facing one another, he points out.
 
Smart idea: Providers should develop a good relationship with the office managers at the physicians' offices from which they receive patients, counsels Fowler. Providers should ask them how to make physicians' jobs easier by getting them the information they need in the manner most convenient for them, she says. Physician practices are inundated with paperwork every day, and it's easy for something essential to a therapist to become a back-burner issue for them.
 
Another tactic: Some therapists cut out the clerical middleman altogether, and send recert forms to physicians directly through their patients, Fowler says. This strategy usually meets with great results, because the patient has the physician sign the form right there in the exam room during his next visit. However, therapists have to make sure the patient is going to remember to give the form to the physician, which sometimes is a problem for elderly patients, she points out. If this is the case, therapists should give the form to a family member or caregiver who will be accompanying the patient to the physician's office, she concludes.
 
Editor's Note: To see the CMS transmittal, go to www.cms.hhs.gov/manuals/pm_trans/R5BP.pdf.