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Treatment Plans for Cardiac Rehabilitation Services
In order for cardiac rehabilitation services to be covered under Medicare, an individualized treatment plan is required. The individualized treatment plan is a written plan tailored to each individual patient and must include all of the following:
- A description of the individual’s diagnosis;
- The type, amount, frequency, and duration of the items and services furnished under the plan; and
- The goals set for the individual under the plan.
A physician must establish, review, and sign the individualized treatment plan every 30 days. The individualized treatment plan must detail how each patient uses each cardiac rehabilitation component.
When submitting records for cardiac rehabilitation services, be sure to send individualized treatment plans that contain all of the required components in a timely manner and ensure that the treatment plans submitted cover the dates of service in question.
What Are We Seeing in Medical Review?
- Providers submitting treatment plans that do not cover the dates of service in question, or the plan is not signed by the provider until several days later, rendering some dates of service noncovered. Many times, one or more of the required elements of the treatment plan are missing.
- A provider’s medical records department receives and responds to the ADR but does not coordinate that response with the clinical department, resulting in an incomplete record submission.
- Irregular uploading of paper records used by the cardiac rehabilitation department to the electronic medical record results in incomplete records for submission.
To avoid these issues which may adversely affect payment, improving communication between the medical records department and the clinical department for a coordinated response to the ADR is recommended.
- Code of Federal Regulations: CFR, Title 42, Chapter IV, Section 410.49
- Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 232
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 32, Section 140
- CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 3, Section 18.104.22.168
- National Coverage Determination (NCD) 20.10: Cardiac Rehabilitation Programs
- MLN® Fact Sheet: Conditions of Coverage for Outpatient Cardiac Rehabilitation Programs