Outpatient Therapy Certification Plan of Care - JE Part A
Outpatient Therapy Certification Plan of Care
Timely certification of the initial plan is met when the physician/NPP certification of the plan is documented, by signature or verbal order, and dated in the 30 days following the first day of treatment (including evaluation). If the order to certify is verbal, follow it within 14 days by a signature to be timely. The patient's medical record should include a dated notation of the order to certify the plan.
However, for dates of service on or after January 1, 2025, when a patient is referred for rehabilitative therapy from a physician or other qualified nonphysician practitioner, the signature requirement for initial certification can be met by evidencing: (1) a signed and dated order; and (2) one-time transmission of the plan of care to the referring provider within 30 days of initial treatment.
Providers must use their discretion to determine the format of the plan of care; however, at a minimum, the following elements are required:
- Diagnoses
- Long-term treatment goals
- Type, amount, duration and frequency of therapy services
- Frequency of therapy refers to "the number of times in a week the type of treatment is provided" which can be tapered as necessary. Long term treatment goals should be measurable and related to the patient’s impairments.
The certification must be retained in the clinical record and available upon request.
