Medicare Audit: 5 requirements

Will your last 10 Medicare evaluations pass these five basic requirements if they were subject to an audit?

Ensuring compliance with Medicare’s five requirements for physical therapy evaluations is crucial not only for maintaining regulatory adherence but also for providing quality patient care. Systems4PT ensures the essential elements of Medicare’s guidelines are confidently adhered to while optimizing patient outcomes. Whether you’re a seasoned practitioner or new to the field, understanding and implementing these guidelines is paramount in delivering effective and compliant physical therapy services under Medicare.

1) Functional Outcome Test – Medicare requires an outcome test for all evaluations, reevaluations, and discharge visits. Systems4PT tracks patient appointments and alerts your clinic when an FOT is due. Our patient portal makes scheduling, sending, and storing patient assessments easier.

2) 150 – 300 Words Defending the Eval Code Severity – Defensive documentation must include analysis of body regions, body systems, body structures, relevant history, co-morbidities, standardized tests, cognitive status, social history, living environment, and clinical presentation. Systems4PT’s automated documentation lets you enter information with just a few clicks of the mouse.

3) Progression of the Identified Functional Deficit(s) – Medicare requires therapists to specify relevant functional deficit(s), including initial severity and forecasted ending severity. Re-evals and Discharge notes must include an evidence-based progression of each deficit. In less than 10 seconds, Systems4PT recommends 75 – 100 evidence-based words that quantify the patient’s functional progression.

4) Plan of Care Defend Each CPT Code’s Role in Restoring the Specified Functional Deficit(s)—You add the treatment plan. Systems4PT instantly recommends clinical rationale, explaining how each exercise, treatment, and modality will restore the specified functional deficit(s). It’s touch-free.

5) Compliant with Medicare’s 10% de minimis rule – Assistant participation must be timed and documented separately from the therapist’s content. The 10% calculation, documentation, and modifier apply to each CPT code for every Medicare date of service. Systems4PT automates the 10% De Minimis Rule calculation and recommends defensive documentation.

The significance of a trustworthy and reliable Electronic Medical Record (EMR) cannot be overstated. A robust EMR system ensures compliant documentation and billing accuracy and is a steadfast companion in navigating the complexities of Medicare regulations. By investing in a reputable EMR solution like Systems4PT, physical therapy practices can fortify their compliance efforts, foster operational efficiency, and ultimately prioritize delivering high-quality care to patients while mitigating risks and ensuring adherence to Medicare’s stringent requirements.