Medicare_Benefit_Policy_Manual / Chapter_15 / 220.1.3

Why This Topic Matters

Understanding these policy requirements helps organizations document therapy plans of care appropriately, support coverage and payment, and reduce avoidable denials or beneficiary liability issues.

Article Sections

1. Method and Disposition of Certifications

   Explains general certification documentation and how certifications are obtained, retained, and reviewed in the clinical record.

2. Initial Certification of Plan

   Covers the first certification interval for a therapy plan of care, including timing and documentation expectations.

3. Review of Plan and Recertification

   Addresses periodic review and recertification for ongoing therapy, along with provider options and professional limitations.

4. Delayed Certification

   Describes how delayed certifications are handled, including documentation that may accompany late certification.

5. Denials Due to Certification

   Summarizes how missing certification can affect claim adjudication, appeal, and liability outcomes.