Required 10th Therapy Visit: Reporting Delays in Active Participation

A client inquired, “Is there a grace period for RPT or OTR involvement after the 10th visit for Medicare Part A or Part B patients?" Yes, CMS does have directives for delays in active participation of the therapist beyond the 10th visit. These regulations are found in the Medicare Benefit Policy Manual, Pub 102, Chapter 15, Section 220.3.

Background

An RPT or OTR must be actively involved in a patient’s care at least once every 10th visit in order to verify that the therapy provided is consistent with the plan of care, to modify the plan of care if necessary, and to ensure that ongoing therapy is properly supervised. Reliance on therapy assistants, typically LPTA’s or COTA’s, to treat patients for 10 visits or more may result in claims denials.

Reporting Delays in Active Participation

We contacted CMS directly to clarify the rules governing 10th visit active participation by therapists for all Medicare beneficiaries. Their guidance is as follows …..

“If the therapist has not written a Progress Report before the end of the Progress Report Period, it shall be written within 7 calendar days after the end of the reporting period. If the therapist did not participate actively in treatment during the Progress Report Period, documentation of the delayed active participation shall be entered in the Treatment Note as soon as possible. The Treatment Note shall explain the reason for the therapist’s missed active participation. Also, the Treatment Note shall document the therapist’s guidance to the assistant or qualified personnel to justify that the skills of a therapist were required during the reporting period. It is not necessary to include in this Treatment Note any information already recorded in prior Treatment Notes or Progress Reports.”

“The contractor shall make a clinical judgment whether continued treatment by assistants or qualified personnel is reasonable and necessary when the therapist has not actively participated in treatment for longer than one reporting period. Judgment shall be based on the individual case and documentation of the application of the therapist’s skills to guide the assistant or qualified personnel during and after the reporting period."

Our Conclusion

Our clinical concern is that “best practices” are applied at all times when treating patients. Providers who allow assistants to treat patients exclusively for long periods of time without an RPT or OTR applying their skills to the patient should re-evaluate both their professional and practice guidelines.

CarePoint therapy management software alerts therapists if, “No RPT or OTR treatment is provided in the last 10 days.” If a patient was treated 7 or more times over the past 10 days and an RPT or OTR did not perform any of the treatments, then this alert is generated regardless of the payer. It appears automatically at key points in CarePoint to ensure that an RPT of OTR is actively involved in a patient’s care as required.