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Documenting Medical Necessity for Palliative Care and Degenerative or Chronic Conditions

Wilson, Christopher M., PT, DPT, DScPT1; Boright, Lori, PT, DPT2

doi: 10.1097/01.REO.0000000000000066
CLINICAL CONVERSATION
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Recently, the Centers for Medicare & Medicaid Services (CMS) clarified that an expectation for functional or clinical improvement was not a requirement to receive payment for physical therapy services. This includes many life-threatening, chronic, or degenerative conditions. This clarification requires a different approach to clinical documentation and clinical decision-making. The onus rests on the physical therapist and the physical therapist assistant to clearly document medical necessity and that interventions required the skill of a physical therapist. Many other private insurance providers still require an expectation of clinical improvement to justify payment for physical therapy.

1Board Certified Geriatric Clinical Specialist; Assistant Professor, Oakland University, Rochester, MI; Education Coordinator, Beaumont Hospital, Troy, MI; and Chairperson, Hospice/Palliative Care Special Interest Group of the Oncology Section of APTA

2Physical Therapist, Ascension St. John Hospital, Warren, MI; and Doctor of Science in Physical Therapy Candidate, Oakland University, Rochester, MI

Correspondence: Christopher M. Wilson, PT, DPT, DScPT, Physical Therapy Program, School of Health Sciences, Oakland University, 433 Meadowbrook Rd, Rochester, MI 48309 (Wilson23@oakland.edu).

The authors declare no conflicts of interest.

©2017 (C) Academy of Oncologic Physical Therapy, APTA
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