An Important Message for Medicare patients
Medicare has specific guidelines that all health care providers must follow when delivering physical, occupational and/or speech therapy.
According to these coverage guidelines, therapy services provided to Medicare patients must be considered "reasonable and necessary," meaning that:
- Because of the complexity of therapy required, such services must be performed by or under the supervision of a qualified therapist.
- There must be an expectation that the individual's condition will improve significantly over a reasonable period of time.
- Therapy must result in functional gains in mobility, activities of daily living, communications and/or safety for the patient.
Note that physical, occupational and/or speech therapy services are not covered by Medicare when they are provided in order to maintain a patient's current level of health or abilities.
Medicare also requires that, as your provider of therapy services, Kessler establish a Plan of Care, which must be signed by the referring physician:
- An initial Plan of Care will be sent to your referring physician, which must be signed and returned to us within 14 days. If it is not received, therapy may not be provided.
- The Plan of Care must be reviewed and signed by the referring physician every 30 days. You will need to schedule a follow-up appointment with your physician before the end of your first month of therapy. If you are unable to see your doctor at that time, please advise your therapist so that we may send the required forms directly to your doctor.
- If your therapy will extend beyond the first 30-day period, a follow-up Plan of Care will also need to be signed by your physician.
- Medicare will not provide coverage for therapy unless the necessary paperwork is complete. It is your responsibility to have your doctor sign the necessary forms for you to continue your therapy without interruption.
If you have any questions or concerns, please speak with your Kessler therapist, a member of our office staff or contact us at one of our locations.