Stride Feature Release
December 30th, 2024
2025 POC Compliance Updates
Effective January 1, 2025, CMS has updated the signed plan of care (POC) rule that a script can serve in lieu of a signed POC.
Rick Gawenda has written a great summary:
CMS finalized their proposal that if a Medicare beneficiary presents to physical therapy, occupational therapy, and/or speech therapy with an appropriate order that documents the type of therapy (PT, OT, or ST), is signed and dated by the physician, physician assistant (PA), nurse practitioner (NP), or clinical nurse specialist (CNS), and the therapist has documented evidence that the plan of care has been delivered to the physician, NP, PA, or CNS within 30 days of completion of the initial evaluation, that this order will serve as the initial certification and a separate signed and dated plan of care by the physician, PA, NP, or CNS will not be required.
For cases with an Initial Evaluation date of January 1, 2025 and later
Given CMS’s update, the Signed POC checklist item will be marked as done if both (1) a physician script has been uploaded to the patient’s case and (2) the POC has been successfully faxed. This will also mark the signed POC as done on the POC report.
A signed POC can still be uploaded to the patient’s case to mark the Signed POC checklist item as done. To clarify, the above update is an additional check to comply with CMS’s update, but a signed POC can always be uploaded to the patient’s case.
For cases with an Initial Evaluation date of December 31, 2024 and earlier
The case checklist and signed POC tracking will continue as they have, requiring a signed POC to be uploaded to the patient’s case in order to mark the Signed POC checklist item as done. An uploaded script will not impact the status of the signed POC.
For reference, here’s a link to Rick Gawenda’s article and here is Medicare’s Final Rule. The updates to physical therapy begin on page 542 with POC updates covered on page 555.
Medicare also published a summary with the sections “Certification of Therapy Plans of Treatment with a Physician or NPP Order” and “Supervision Policy for Physical Therapists (PTs) and Occupational Therapists (OTs) in Private Practice”.
Watch here:
Accumulation Trackers
New alerts on calendar appointment popups
Appointment popups will show alerts for patient’s deductible (ded.), out-of-pocket (OOP) maximum, insurance visit limits, and case max visits. When hovering on these alerts you will see the current amount remaining until the threshold is reached.
These alerts will appear in red, yellow, and green based on the status. Spend Accumulators are deductible and out-of-pocket maximum. Visit Trackers are insurance visit limits and case max visits.
- Red: this is an important alert that needs to be taken into consideration
- Spend Accumulators: >$400 remaining
- Visit Trackers: 0-2 visits remaining
- Yellow: this alert has no immediate action, but should be monitored
- Spend Accumulators: $1-$400 remaining
- Visit Trackers: 3-5 visits remaining
- Green: this alert is not critical at this time
- Spend Accumulators: $0; has been met
- Visit Trackers: 6+ visit remaining
New note creation alerts
If a patient’s case has a value entered for case max visits, when a clinician starts a note they will see a countdown of how many visits are remaining of the total maximum allowed visits.
Automatic deductions from insurance fields
The remaining amounts for a patient’s deductible, out-of-pocket maximum, insurance visit limits, and case max visits will decrease as the patient continues care. Additionally, for traditional Medicare patients the KX modifier accumulator will increase.
Spending Accumulators
The deductible remaining and out-of-pocket maximum remaining fields will decrease by the dollar amount in Settings (the default is $100, see below for making updates) once a note has been signed. The update is based on signed notes to align with the generation of claims.
The KX modifier accumulator will increase by the same amount for each additional signed note.
Visit Trackers
The insurance visits remaining and case max visits will decrease by 1 visit. The insurance visits remaining field will decrease once the note has been signed. The case max visits field will decrease for all past appointments marked as checked-in.
Setting spending accumulator deduction amounts
There are two settings options for how much should be deducted from patients’ spending accumulators - deductibles and out-of-pocket maximums - and how much will be added to a patients’ KX modifier accumulator.
The default setting for all payers can be found on Settings > General at the bottom of the page. Here you can set the default values for in-network and out-of-network benefits.
Additionally, individual payers can have their own override for the deduction amount by going to Settings > Payers and clicking edit on the payer you want to update. Under the Compliance / Billing Rules tab scroll to the bottom to Insurance Coverage to set the override amount for this specific payer.
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