I recently join out-patient facility where I have Medicare patients.
I need basic guideline for Medicare Cap $1880 & Non-cap.
1. Patient comes with Physical therapy Prescription from Physician.
2. Physical Therapist (PT) Evaluate the patient & prepare Plan of Care (POC) short & long term goal for 3 times/week for 4 weeks.
3. Send Plan of care to referring Physician for certify withing 24 hours.
If physician will not send POC with certification, what should PT do? S/he has to continue the therapy?
4. Around 30 days PT reevaluate the patient & prepare new short & long term goal or continue the same goal.
5. Patient used 18 visits within 6 weeks (reach cap limit).
6. PT don't feel any improvement or patient reach their desire goal and PT discharge the patient and send discharge note to referring physician.
7. After a week patient comes with new prescription from same physician for continue physical therapy.
Manager and Physician force to PT that add KX modifier and continue PT. Now what is PT's role or next step?
PT has already discharge the patient because S/he is not getting improvement from physical therapy treatment. As physician referring patient with prescription PT can again start the treatment? What should PT mention in document/evaluation?
Expert please advise.
