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90 day certification for Medicare

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90 day certification for Medicare - February 29, 2008 3:12:42 PM   


Posts: 227
Joined: May 25, 2007
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Effective in January 2008, the Medicare rule for certification of outpatient physical was supposed to change from 30 days to 90 days. However, I have not seen any official notification about the change.

How are other therapists handling this situation? I am still using the old 30 day rule. One resource, RCRI, has this on their web page -

We have had many questions about Medicare contractors who have not yet implemented the transition to the 90 Day certification, and people are wondering what they should do. Although the Final Rule, published on November 2, 2007, changed the rule on the timeline for recertification of Plans of Care under the Medicare program, CMS has not yet released its Change Request (CR) providing instructions to state contractors on how to administer these changes. The hold up on this appears to be an administrative policy change at CMS that is designed to release the Change Requests in groups. The current plan appears to be to release the CR to contractors in April of 2008. Therefore, although technically the 90 Day recertification process is in place, in order to avoid problems and ensure timely payment without the need to appeal any technical denials, it is advisable to continue to proceed as if the recertification period is 30 days. Once the CR has been published, we will post it on this web page, and contractors will have the instructions they need to enable them to implement the change from 30 to 90 days.
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RE: 90 day certification for Medicare - February 29, 2008 6:30:10 PM   


Posts: 3332
Joined: May 11, 2004
From: Michigan
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I'm still using the old 30 day rule.  The 90 day rule is in effect.  I plan on continuing the old 30 day rule - progress notes are due anyways (every 10 visits or 30 days) and I'd like to maintain open communication with the physicians.  Also, I'll admit, I'm lazy and don't want to change my forms again AND other payors haven't changed to a 90 day deal here in this state, so for consistency across the board to keep life simple, 30 days it will stay for me.

(in reply to buckeye)
Post #: 2
RE: 90 day certification for Medicare - March 1, 2008 4:04:36 AM   


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Joined: October 13, 2003
Status: offline
I contacted medicare with some of the same questions in the beginning of the year. according to the medicare director, no contractor will be able to deny payment for any services in 2008 in which the 90 day rule was used, as long as the 90 day POC began and was signed on or after the 1st of the year. This person stated that the reason intermediaries don't have yet, is that there is a few months lag time btwn the new rule being changed and going into affect . (red tape basically).
In MA, as with SJBird's post, even though the medicare rule may have changed, under our state practice act, we still must re-eval every 30 days any way, so at that point, you might as well send it to the MD since it's not extra work, and they stay informed on what we are doing on our end. The only thing is, we don't necessarily need the PR to be signed and returned if it's less than the 90 days.

hope this helps.

(in reply to SJBird55)
Post #: 3
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