Medicare Monthly Review, Issue 2008-03AB: Physical Therapy (PT) Services Impacting National Government Services CERT Error Rate

Content Section

Note: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material which is copyrighted by the American Medical Association (AMA). You are forbidden to download the files unless you read, agree to and abide by the provisions of the copyright statement. Read the copyright statement now (you will be linked back to here).

	National Government Services, Inc. Medicare Monthly Review Part A and B
A Combined Part A and Part B Newsletter

MMR-2008- 03AB, March 2008

Physical Therapy (PT) Services Impacting National Government Services CERT Error Rate

In 2008, National Government Services will continue to focus on increasing provider awareness of the errors contributing to our Comprehensive Error Rate Testing (CERT) error rate. The Centers for Medicare & Medicaid Services (CMS) continues to make CERT error rate goals more aggressive, and it is vital that we meet or exceed those goals.

Analysis from our current CERT findings shows that physical therapy (PT) services make up a significant portion of our CERT insufficient documentation errors. The primary issue is that the documentation submitted to the CERT contractor is missing one or more of the required elements.

Listed below are the most common documentation requirements that are missing for PT services:

Ordering and/or referring physician
Signed and dated certification by the referring provider
Initial and reevaluations
Treatment plan for the billing period, listing modalities rendered and signed and dated by the physician.

(If treatment plan is not signed by physician, submit physician order form or progress note with modalities listed, signed and dated by physician.)

Documentation to support services and all treatment modalities for the billed date of service
Documentation of time to support the number of units billed

Additional problem areas that we have identified include:

When billing 97140, 97110, and 97112, providers often do not document the specific modalities of treatment with minutes and/or time that make up these codes. These codes sometimes represent multiple exercises or types of activities. For each treatment modality, clarification of exact amount of minutes and/or time is required. Without the support of modalities with time clarification of why more than one unit of service is necessary, often only one unit may be allowed.
Progress must be documented in treatment/progress notes. Progress needs to be measurable and should start with the initial evaluation baseline measurements. Measurements should be reported regularly to support progress toward goals.
Goals need to be specific and measurable - Use range of motion, strength, pain scales, etc. to set goals and then use those measurements throughout the treatment period.
Therapy notes and logs are often difficult to read. Please be sure to document legibly and include any graphs, legends, flow sheets, abbreviation keys, etc. that may clarify documentation.
The time counted is the time the patient is treated. The time the patient spends resting, waiting to use a piece of equipment, or for other treatment to begin is not considered treatment time.
Include the Discharge Report, when the patient had been discharged at the time the claim was submitted.

For further information concerning physical medicine and rehabilitation procedures and modalities (see specific carrier LCD) or the CERT program visit our Web site at www.NGSMedicare.com.