Guest guest Posted June 24, 2011 Report Share Posted June 24, 2011 There is absolutely no requirement by Medicare that a patient be seen for a specific frequency. When the therapist prepares the plan of care, he/she determines the frequency and duration, and sends it to the physician for certification. Medicare even allows you to " taper " visits over the course of the plan of care as the patient improves. Leigh , MSPT San Francisco, CA > > > > Hi everyone, > > I was looking through all the Medicare information for guidelines on how many times a week & nbsp; Medicare patients should be treated. > I've heard that they need to come in 3x a week. We have some patients who only want to come in once or twice a week. > Also the patients rx states 3x a week, but they don't want to come in 3x week. Should we request a changed rx? > Please guide me in looking for this information so we could make sure patients are getting the correct amount in treatment. > > Thanks, > > > JCPT NJ > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 25, 2011 Report Share Posted June 25, 2011 Here is the language from CMS Pub 100-02, Chapter 15, Section 220.1.2B. The link is posted below for your access. The frequency refers to the number of times in a week the type of treatment is provided. Where frequency is not specified, one treatment is assumed. If a scheduled holiday occurs on a treatment day that is part of the plan, it is appropriate to omit that treatment day unless the clinician who is responsible for writing Progress Reports determines that a brief, temporary pause in the delivery of therapy services would adversely affect the patient’s condition. The duration is the number of weeks, or the number of treatment sessions, for THIS PLAN of care. If the episode of care is anticipated to extend beyond the 90 calendar day limit for certification of a plan, it is desirable, although not required, that the clinician also estimate the duration of the entire episode of care in this setting. The frequency or duration of the treatment may not be used alone to determine medical necessity, but they should be considered with other factors such as condition, progress, and treatment type to provide the most effective and efficient means to achieve the patients’ goals. For example, it may be clinically appropriate, medically necessary, most efficient and effective to provide short term intensive treatment or longer term and less frequent treatment depending on the individuals’ needs. It may be appropriate for therapists to taper the frequency of visits as the patient progresses toward an independent or caregiver assisted self management program with the intent of improving outcomes and limiting treatment time. For example, treatment may be provided 3 times a week for 2 weeks, then 2 times a week for the next 2 weeks, then once a week for the last 2 weeks. Depending on the individual’s condition, such treatment may result in better outcomes, or may result in earlier discharge than routine treatment 3 times a week for 4 weeks. When tapered frequency is planned, the exact number of treatments per frequency level is not required to be projected in the plan, because the changes should be made based on assessment of daily progress. Instead, the beginning and end frequencies shall be planned. For example, amount, frequency and duration may be documented as “once daily, 3 times a week tapered to once a week over 6 weeksâ€. Changes to the frequency may be made based on the clinicians clinical judgment and do not require recertification of the plan unless requested by the physician/NPP. The clinician should consider any comorbidities, tissue healing, the ability of the patient and/or caregiver to do more independent self management as treatment progresses, and any other factors related to frequency and duration of treatment. http://www.cms.gov/manuals/Downloads/bp102c15.pdf Rick Gawenda, PT President Gawenda Seminars & Consulting, Inc. www.gawendaseminars.com See upcoming audio conferences at http://www.gawendaseminars.com/news.aspx Subject: Re: MEDICARE GUIDELINES To: PTManager Date: Friday, June 24, 2011, 10:43 PM  There is absolutely no requirement by Medicare that a patient be seen for a specific frequency. When the therapist prepares the plan of care, he/she determines the frequency and duration, and sends it to the physician for certification. Medicare even allows you to " taper " visits over the course of the plan of care as the patient improves. Leigh , MSPT San Francisco, CA > > > > Hi everyone, > > I was looking through all the Medicare information for guidelines on how many times a week & nbsp; Medicare patients should be treated. > I've heard that they need to come in 3x a week. We have some patients who only want to come in once or twice a week. > Also the patients rx states 3x a week, but they don't want to come in 3x week. Should we request a changed rx? > Please guide me in looking for this information so we could make sure patients are getting the correct amount in treatment. > > Thanks, > > > JCPT NJ > > > > > > Quote Link to comment Share on other sites More sharing options...
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