"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Wednesday, February 27, 2008

PT Clinical Management

I got this e-mail from one of my clinic managers regarding our latest update to the Physician Re-certification Note (which, for Medicare purposes doubles as our Progress Note).

Eric and I regularly bounce ideas off of one another in order to improve the compliance of our Medicare treatments.

The point of this post is to emphasize that, in small PT practices, Medicare compliance is a two-way street. Everyone needs to be on board. Everyone needs to be committed.

Here is the e-mail exchange.

Real Time Clinical Management

From: Eric
Sent: Wednesday, February 27, 2008 6:23 PM
To: Tim Richardson PT
Subject: Re-certification note revision


I see no problem with adding the Justification Statement for Physical Therapy. I don’t need the reference for this, but some examples sure would help.

Also, would you consider removing the goals met line? I could use an extra Impairment line and I will usually write (Met) on the line over (Goal) instead of checking off the box.



Great question.

Once you've demonstrated Medical Necessity (in the POC) there is no further need in the daily Treatment Encounter notes to do so.

However, if you elect to continue the patient a 2nd 30-day period you should show, in the Progress Note, both Medical Necessity and the Expectation of Significant Improvement in a Predictable Timeframe (30 days).

If, for whatever reason, either of these criteria are not immediately obvious from the measurements, the OPTIMAL, the disability statements or from the Treatment Encounter Notes then you should, in the plainest language possible, state so in the Justification Statement.

For Example:

"Continue PT TIW x 4 weeks b/c diabetic frozen shoulder is taking longer than a 'regular' frozen shoulder."


"Continue PT TIW x 4 weeks. Patient motivated and ready to get back to PT after d/c from hospital for chemo"


"Continue PT TIW x 4 weeks. New Goals as follows..."
(note: new goals should progress patient to a higher level of function as demonstrated by serial (bi-monthly) OPTIMAL scale)


"All LTG met. Continue PT BIW x 2 weeks for instruction in maintenance program at fitness center"


"Continue PT TIW x 4 weeks. Patient very old (89 yo) and debilitated (100#) and Ther Ex is very slow."

Whatever, as long as the language makes sense and can be backed with measurements.

Remember, measurements and the interpretation of measurements is how you demonstrate Skilled Therapy (the only requirement for the daily Treatment Encounter Note).

Remember, once the patient hits the cap ($1,810.00 for 2008) there is the Automatic Exception based on Medical Necessity.

Don't use the diagnosis list only as your basis for an exception.

Remember your list of complexities and conditions that contribute to the Automatic Exception.

Bottom line, let the needs of your patient drive your therapy recommendations.

Call me if you have any questions.

I will ask Greg if he wants the 'Goals Met' sequence to be deleted.


Free Tutorial

Get free stuff at BulletproofPT.com

Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

"Make Decisions like Doctors"

Copyright 2007-2010 by Tim Richardson, PT.
No reproduction without authorization.

Share PTD with your Peers!

American Physical Therapy Association

American Physical Therapy Association
Consistent with the American Physical Therapy Association Vision Statement for Physical Therapy 2020, the American Physical Therapy Association supports exclusive physical therapist ownership and operation of physical therapy services.