What does Medicare require for a certification?

Certification requires a dated signature on the plan of care or some other document that indicates approval of the plan of care.

The physician’s/NPP’s certification of the plan (with or without an order) satisfies all of the certification requirements for the duration of the plan of care, or ninety (90) calendar days from the date of the initial treatment, whichever is less. The initial treatment includes the evaluation that resulted in the plan.

When does the POC need to be certified?

The provider or supplier (e.g., facility, physician/NPP, or therapist) should obtain certification as soon as possible after the plan of care is established, unless the requirements of delayed certification are met. “As soon as possible” means that the physician/NPP shall certify the initial plan as soon as it is obtained, or within thirty (30) days of the initial therapy treatment.

Timely certification of the initial plan is met when physician/NPP certification of the plan is documented, by signature or verbal order, and dated in the thirty (30) days following the first day of treatment (including evaluation).

Can the certification be done verbally?

If the order to certify is verbal, it must be followed within 14 days by a signature to be timely. A dated notation of the order to certify the plan should be made in the patient’s medical record.

When is recertification required?

Recertifications that document the need for continued or modified therapy should be signed whenever the need for a significant modification of the plan becomes evident, or at least every ninety (90) days after initiation of treatment under that plan, unless they are delayed.

References

Medicare Benefit Policy Manual Ch. 15 – Covered Medical and Other Health Services § 220.1.3

Billing and Coding: Outpatient Physical and Occupational Therapy Services: A57067