Common Outpatient Rehabilitation Therapy CERT Errors

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Billing Part B Outpatient Therapy Services

Outpatient rehabilitation therapy includes Physical Therapy (PT), Occupational Therapy (OT), and Speech-Language Pathology (SLP) services. Medicare covers outpatient PT, OT, and SLP services when:

• A physician or Non-Physician Practitioner (NPP) certifies the “treatment plan,” called the Plan of Care (POC), ensuring:
  • A patient needs therapy services 
  • POC is: 
    • Established by a physician, NPP, our qualified therapist provides services 
    • Reviewed periodically by a physician or NPP 
  • A patient gets services under physician care 
• POC certifying the provider’s name and NPI is on the claim 
• Providers meet medical necessity, documentation, and coding requirements

where, 

• CERT: Comprehensive Error Rate Testing
• A physician is a Doctor of Medicine, osteopathy, podiatric medicine, and optometry (only for low vision rehabilitation). 
• NPP includes a Physician Assistant (PA), Clinical Nurse Specialist (CNS), or Nurse Practitioner (NP). 
• A qualified Therapist includes a PT, OT, or SLP who meets regulatory qualifications as applicable, including state licensure or certification.

Common Outpatient Rehabilitation Therapy CERT Errors

• Missing certification and recertification(s): Physician’s, NPP’s, or therapist’s dated signature(s) approving the POC. Prevention: Confirm physician or NPP certified the POC (and recertified it when appropriate) with their signature and date.
• Missing signature: Physician, NPP, or therapist who developed the POC and established treatment plan date. Prevention: Ensure you add your dated signature and professional identification (for example, PT, OT).