Episodes with PT? Palmetto agencies better state ‘short-term’ and ‘long-term goals’

Effective Dec 4, 2014
Published Dec 8, 2014
Last Reviewed Dec 4, 2014

When it comes to episodes with physical therapy, agencies that bill Medicare administrative contractor (MAC) Palmetto GBA may be in for a surprise: Claims can be denied when documentation fails to show both short-term and long-term goals for the patient. A number of agencies recently learned the hard way that without both, they wouldn’t be reimbursed and that appealing such denials could land them in the more than three-year wait for an administrative law judge (ALJ) hearing. Adding to the uncertainty is a Palmetto article, released Oct. 30, that states short-term and long-term goals aren’t always necessary.

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