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[quote=Anonymous][quote=Anonymous]Medicare is not supposed to deny outpatient therapy because the patient has plateaued. https://hurleyeclaw.com/skilled-nursing-cant-end-because-youve-plateaued/ describes this issue (don't be dissuaded by the title--as the article says, it's true for skilled nursing, but also for outpatient therapy). You may have appeal rights.[/quote]

This is interesting. I'm an outpatient PT, and we are always told we have to justify the need for skilled care in our documentation. We take that to mean that if anyone could supervise the exercises that we are doing with the patient/the patient can do them on their own, and it doesn't require my expertise, we have justification to discharge the patient.  Absolutely we agree that most patients need to keep doing exercises after discharge, it's just means on their own, not with formal PT. Once we hit the outpatient Medicare cap we have to bill with a modifer that tells Medicare that we have gone over 18-20 visits for the year at which point they may start auditing the notes and decide not to pay. Usually this is after we have already seen them a bunch more times already. Like it or not, patients have to do exercises at home on their own, consistently, and push themselves for any appreciable change, even with regular PT office visits. This is difficult for many many people (of all ages and issues).[/quote]

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