Page 229 - Medicare Benefit Policy Manual

• Maintain a complete and timely clinical record on the patient which includes
diagnosis, medical history, orders, and progress notes relating to all services
received;

• Maintain liaison with the attending physician/NPP with regard to the progress of
the patient and to assure that the required plan of treatment is periodically
reviewed by the physician/NPP;

• Secure from the physician/NPP the required certifications and recertifications;
and

• Ensure that the medical necessity of such service is reviewed on a sample basis by
the agency’s staff or an outside review group.

In addition, when a provider provides outpatient services under an arrangement with
others, such services must be furnished in accordance with the terms of a written contract,
which provides for retention by the provider of responsibility for and control and
supervision of such services. The terms of the contract should include at least the
following:

• Provide that the therapy services are to be furnished in accordance with the
plan of care established according to Medicare policies for therapy plans of
care in section 220.1.2 of this chapter;

• Specify the geographical areas in which the services are to be furnished;

• Provide that contracted personnel and services meet the same requirements as
those which would be applicable if the personnel and services were furnished
directly by the provider;

• Provide that the therapist will participate in conferences required to coordinate
the care of an individual patient;

• Provide for the preparation of treatment records, with progress notes and
observations, and for the prompt incorporation of such into the clinical records
of the clinic;

• Specify the financial arrangements. The contracting organization or
individual may not bill the patient or the health insurance program; and

• Specify the period of time the contract is to be in effect and the manner of
termination or renewal.

B. Special Rules for Hospitals