The Comprehensive Outpatient Rehabilitation Facility (CORF) has been around as a Medicare entity for 26 years. In a CORF, a plan of care may be certified for 60 days (which has always been the case). A number of years ago the regulations were changed to state that the physician must develop the plan of care, rather than the physical, occupational or speech therapist who is evaluating the patient. In all other venues of outpatient rehab the therapist evaluates the patient and develops the plan of care that is sent to the referring physician for Medicare certification.
A number of providers have reported that when their records were reviewed under an ADR request that they were caught by surprise to be denied on the entire claim because the Plan of Care was developed by the therapist, and only certified by the physician. The regulations state that in a CORF the plan of care must be developed by a physician. One provider reported that the fiscal intermediary denied the Plan of Care based upon the fact that the hand written plan of care did not match the hand writing of the physician in the signature box!
In a CORF the Plan of Care may be certified for 60 days, which has always been the case. Don’t be confused with Medicare documenation requirement that allow the Plan of Care to be certified for up to 90 days (except for CORFs and Rehab Agencies). For Plans of Care not properly certified rehab providers face the risk of having all services provided under the Plan disallowed.