Page 168 - Medicare Benefit Policy Manual

INTERVAL of certified treatment (certification interval) consists of 90 calendar days or
less, based on an individual’s needs. A physician/NPP may certify a plan of care for an
interval length that is less than 90 days. There may be more than one certification
interval in an episode of care. The certification interval is not the same as a Progress
Report period.

MAINTENANCE PROGRAM (MP) means a program established by a therapist that
consists of activities and/or mechanisms that will assist a beneficiary in maximizing or
maintaining the progress he or she has made during therapy or to prevent or slow further
deterioration due to a disease or illness.

NONPHYSICIAN PRACTITIONERS (NPP) means physician assistants, clinical nurse
specialists, and nurse practitioners, who may, if state and local laws permit it, and when
appropriate rules are followed, provide, certify or supervise therapy services.

PHYSICIAN with respect to outpatient rehabilitation therapy services means a doctor of
medicine, osteopathy (including an osteopathic practitioner), podiatric medicine, or
optometry (for low vision rehabilitation only). Chiropractors and doctors of dental
surgery or dental medicine are not considered physicians for therapy services and may
neither refer patients for rehabilitation therapy services nor establish therapy plans of
care.

PATIENT, client, resident, and beneficiary are terms used interchangeably to indicate
enrolled recipients of Medicare covered services.

PROVIDERS of services are defined in §1861(u) of the Act, 42CFR400.202 and
42CFR485 Subpart H as participating hospitals, critical access hospitals (CAH), skilled
nursing facilities (SNF), comprehensive outpatient rehabilitation facilities (CORF), home
health agencies (HHA), hospices, participating clinics, rehabilitation agencies or
outpatient rehabilitation facilities (ORF). Providers are also defined as public health
agencies with agreements only to furnish outpatient therapy services, or community
mental health centers with agreements only to furnish partial hospitalization services. To
qualify as providers of services, these providers must meet certain conditions enumerated
in the law and enter into an agreement with the Secretary in which they agree not to
charge any beneficiary for covered services for which the program will pay and to refund
any erroneous collections made. Note that the word PROVIDER in sections 220 and 230
is not used to mean a person who provides a service, but is used as in the statute to mean
a facility or agency such as rehabilitation agency or home health agency.

QUALIFIED PROFESSIONAL means a physical therapist, occupational therapist,
speech-language pathologist, physician, nurse practitioner, clinical nurse specialist, or
physician’s assistant, who is licensed or certified by the state to furnish therapy services,
and who also may appropriately furnish therapy services under Medicare policies.
Qualified professional may also include a physical therapist assistant (PTA) or an
occupational therapy assistant (OTA) when furnishing services under the supervision of a
qualified therapist, who is working within the state scope of practice in the state in which