Medicare Plans of Care and Progress Reports

In my experience, Medicare requirements for tracking Progress Reports and Plans of Care are a source of confusion for many Physical and Occupational Therapists. Anyone who treats Medicare patients should review these requirements in detail by reviewing the appropriate Medicare Policy Manual. (Chapter 15, which covers most outpatient clinics, is linked here:  Medicare Benefits Policy Manual.)

This is a very brief summary of those requirements for most settings:  A Plan of Care (POC) is established as part of the evaluation by the therapist. The POC can be as long as 90 days, but may be shorter. The Plan of Care must be reviewed and approved by the referring physician in a reasonable time and you are responsible to keep a written record of the POC Approval.  A new Plan of Care must be done if the there is a substantial change to the plan.
In addition to the POC, there is a separate requirement for a written Progress Report that must be sent to the referring physician at least every 10 visits or 30 calendar days, whichever comes first. The Progress Report does not require physician approval and does not take the place of a POC.