Outpatient Therapy Certification Plan of Care - JE Part B

Certification is required for all therapy claims. While the order for therapy services provides confirmation that the patient is under the care of a physician and needs that care, signing the plan of care completes the certification requirements and proves that a physician is involved in the care and available to certify the plan. Payment of therapy claims relies on the certification of the plan of care and not the order.

Providers must use their discretion to determine the format of the plan of care; however, at a minimum, the following elements are required:

• It must be dated and in written format
• Legible dated signature and credentials of the professional who established the plan
• Legible dated signature of the certifying physician/NPP
• Diagnoses
• Long-term treatment goals
• Type, amount, duration and frequency of therapy services

The certification must be retained in the clinical record and available upon request.

Resources

• Internet Only Manual (IOM) Medicare Benefit Policy Manual, Publication 100-02, Chapter 15, Sections 220, 220.1, 220.1.1, 220.1.2, 220.1.3