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Spotlight

Outpatient rehabilitation therapy services: complying with documentation requirements

Learn about common outpatient rehabilitation therapy services Comprehensive Error Rate Testing (CERT) Program errors and related billing requirements.

LCD / NCD – policy information

LCDs
Search for rehabilitation-related LCDs using these available resources:

• LCD interactive index tool
• View First Coast’s active / proposed LCDs / articles on CMS’ Medicare coverage database (MCD)

NCD

• Search CMS’ MCD
• CMS’ MCD - NCD alphabetical index

Medical documentation

Medical record documentation is used to verify that services were billed correctly and to ensure that payment and processing of Medicare claim(s) are accurate and based on sound policy.  Find information, tips, and resources regarding medical documentation.

Checklist: Outpatient therapy and rehabilitation services documentation

FAQs

Before you call the First Coast provider contact center, find answers to FAQs on First Coast’s and/or CMS’ website.

• View our specialty/services FAQs for additional information

View the following FAQs on the CMS website:

• Therapy caps and advance beneficiary notice of noncoverage (ABN), form CMS-R-131 FAQs

Education

• How to Avoid Common Medicare Outpatient Therapy Denials
• On-Demand Learning – specialty services

View additional educational information from First Coast and CMS on rehabilitation services:

More

CMS internet-only manuals (IOM)

The CMS’ IOMs contain day-to-day operating instructions, policies, and procedures based on statutes, regulations, guidelines, models, and directives. The following CMS IOMs contains information specific to rehabilitation service providers:

• Publication 100-02 -- Medicare Benefit Policy Manual – Chapter 12
• Publication 100-04 -- Medicare Claims Processing Manual -- Chapter 15
• Part B outpatient rehabilitation and CORF/OPT services -- Chapter 5

Resources

Listed below are additional resources identified specifically for rehabilitation service providers:

• CMS’ annual therapy update
• CMS’ therapy services
• American Physical Therapy Association (APTA)
• CMS’ Billing examples using CQ/CO modifiers for services provided by physical therapy assistants (PTAs)and occupational therapy assistants (OTAs)
• Counting units for therapy codes

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