Eli's Rehab Report

Question: Your October article on occupational therapy billing stated that the physiatrist must sign off on the patients treatment plan every 30 days. But what if the patient is in a nursing facility? Can the lead nurse sign off on the plan, or does it have to be done by the physician? Most of our stroke (436) patients receive some occupational therapy, and the physician sometimes tells us to continue the plan, but doesnt necessarily sign it.

Michigan Subscriber

Answer: The Medicare Carriers Manual, section 2215, requires that the patients private physician, or a physician affiliated with the institution, must review the patients treatment plan every 30 days. Each review must contain the physicians initials and the date of review in the file. In addition, the therapists claim forms for therapy must include the physicians name and the date he or she last saw the patient. For that reason, the nurse at the facility cannot sign off on the treatment plan, but a physician associated with the nursing facility can do so.

If the physician verbally directs the therapist to change the plan of treatment less than 30 days after he or she approved the most recent plan, the therapist must immediately record the physicians new orders in the patients records and sign it.