Page 178 - Medicare Benefit Policy Manual

each discipline separately. For example, a physical therapist may not provide services
under an occupational therapist plan of care. However, both may be treating the patient
for the same condition at different times in the same day for goals consistent with their
own scope of practice.

The amount of treatment refers to the number of times in a day the type of treatment will
be provided. Where amount is not specified, one treatment session a day is assumed.

The frequency refers to the number of times in a week the type of treatment is provided.
Where frequency is not specified, one treatment is assumed. If a scheduled holiday
occurs on a treatment day that is part of the plan, it is appropriate to omit that treatment
day unless the clinician who is responsible for writing progress reports determines that a
brief, temporary pause in the delivery of therapy services would adversely affect the
patient’s condition.

The duration is the number of weeks, or the number of treatment sessions, for THIS
PLAN of care. If the episode of care is anticipated to extend beyond the 90 calendar day
limit for certification of a plan, it is desirable, although not required, that the clinician
also estimate the duration of the entire episode of care in this setting.

The frequency or duration of the treatment may not be used alone to determine medical
necessity, but they should be considered with other factors such as condition, progress,
and treatment type to provide the most effective and efficient means to achieve the
patients’ goals. For example, it may be clinically appropriate, medically necessary, most
efficient and effective to provide short term intensive treatment or longer term and less
frequent treatment depending on the individuals’ needs.

It may be appropriate for therapists to taper the frequency of visits as the patient
progresses toward an independent or caregiver assisted self-management program with
the intent of improving outcomes and limiting treatment time. For example, treatment
may be provided 3 times a week for 2 weeks, then 2 times a week for the next 2 weeks,
then once a week for the last 2 weeks. Depending on the individual’s condition, such
treatment may result in better outcomes, or may result in earlier discharge than routine
treatment 3 times a week for 4 weeks. When tapered frequency is planned, the exact
number of treatments per frequency level is not required to be projected in the plan,
because the changes should be made based on assessment of daily progress. Instead, the
beginning and end frequencies shall be planned. For example, amount, frequency and
duration may be documented as “once daily, 3 times a week tapered to once a week over
6 weeks”. Changes to the frequency may be made based on the clinicians clinical
judgment and do not require recertification of the plan unless requested by the
physician/NPP. The clinician should consider any comorbidities, tissue healing, the
ability of the patient and/or caregiver to do more independent self-management as
treatment progresses, and any other factors related to frequency and duration of
treatment.