Medicare ADVISOR Q&A

When is a New Script Needed?

When is a New Script Needed?; Performing Patient Screens

Question: From which date does the therapist count the 30 days before a new script is needed? In my past experience working in an outpatient PT setting (hospital based), we began the certification date from the initial PT exam date. This was done provided the MD had seen the patient within the previous two weeks. If the patient waited more than 2 weeks to see a therapist then we requested a new script. 

Now that I am working in a private practice, I was advised that the 30 day count begins from the date the prescription is written by the MD. To me, that would mean that the patient may lose a week or so when it comes to the certification process as it does take time to schedule an appointment with a therapist. 

The certification begins the date of the first therapy visit, meaning the day the patient is evaluated, and not the date the physician wrote the order. A physician script is valid for one year from the issue date so there is no reason to get another script. Under the present regulations, Medicare does not require that the patient see the physician prior to obtaining a referral to therapy.

Beginning January 1, 2008, Medicare will have new regulations regarding the period of certification. It is being changed from 30 days to "up to 90" days before an updated plan of treatment is required for recertification. So under the new regulations, you will need to identify the duration of the plan to match your long term outcomes date. So, for example, if your long term goal achievement date is for six weeks, then your plan of treatment will read 3x/week for 6 weeks.

Medicare also allows the use of a number of treatments, so the plan could read 10 treatments. This is especially good for the patient who is waiting for an orthotic, prosthetic, or a wheelchair prior to completing physical therapy.

Question: As a PTA, my PT sends me to the Nursing Home to perform screens on the residents. She then has me bring the paper work back to her and she says she has to sign it. It is done in my hand writing and she signs as the therapist performing the screen. Nowhere is my name on the paperwork as a PTA having performed the patient screen. I am concerned about this practice.

Screens are simply a device used to determine if a resident might benefit from therapy. Screens are not reimbursable by Medicare and CMS has no regulations on screens, and as such, screens are not addressed anywhere in the Medicare Manuals. What you need to be aware of is whether or not there is anything in your practice act that says screens must be performed by a PT rather than a PTA. If there is, then she is in violation of the practice act as well as fraudulently signing documentation as if she had performed it.

We recommend that you sign the screen and she can co-sign as having read it, NOT performed it. We have concerns about anyone who puts in the medical record a document that is signed by them, but is performed by someone else.

If you have a question about Medicare reimbursement you would like the authors to address, send your question and contact information to Medicare Advisor, c/o Lisa Lombardo, ADVANCE for PTs & PTAs, 2900 Horizon Dr., King of Prussia, PA 19406; fax 610-278-1425;

Pauline Franko is owner of Encompass Consulting & Education, LLC, a rehabilitation consulting and education company based in Tamarac, FL. The company's "Direction on Demand" service specializes in providing the rehabilitation professional with a clear, easy way to understand how to provide Medicare compliant services to their patients in the SNF and Outpatient settings. As a principle in Comprehensive Medicare Consultants, LLC, she is responsible for assisting with and directing compliance programs to Rehab Agencies. Danna Mullins is an associate and lecturer with Encompass. You may contact the authors through the Encompass website at or by phone at 954-720-4087

Medicare Advisor Archives

Do the new Medicare certification guidelines apply for therapy services provided in a skilled nursing facility?

Rachael Nichols,  Regional Rehab DirectorDecember 20, 2007
Carmel, IN

Do the new certification guidelines (from 30 days to up to 90 days)go into effect January 1, 2008? I thought that I read they go into effect in July 2008??

Yvette December 18, 2007


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