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Plan of Care FAQs

What is required in a Plan of Care?

Click here to read more about Medicare POC rules.

Where can I learn more about the new Plan of Care (POC) Alerts feature?

Click here to learn more about POC alerts.

Why are there alerts for the Plan of Care dates?

We’ve had numerous requests from Members to add the Plan of Care (POC) compliance feature to the EMR to ensure adherence to Medicare guidelines. Finalizing Medicare notes outside the established plan of care could result in denied claims.

A patient has an expired POC; what should I do next?

For a patient with an expired POC, the therapist should create an evaluative note such as a progress note, but could also include a re-examination or re-certification note. You do not need to bill an examination CPT code; you can bill as you normally would on a daily note. Once you establish new plan dates on the plan tab and finalize the note, you can complete daily notes again.

Should I add an evaluation and no charge for it; then create a daily note?

No, this creates unnecessary work. Instead, add an evaluative note—like a progress note—and bill as you normally would for a daily note.

Should I addend a past evaluation to change the plan of care dates?

No. Do not add addenda to past evaluations as referring physicians had to sign off on the original dates. A new evaluative note—like a progress note—should be created.  

Do I have to charge an examination code if I create an evaluative document, like a progress note or re-examination?

No, you do not need to charge for an examination if it is not necessary or warranted. You can choose to charge out as you would normally on a daily note if that is what the visit calls for.

Where are the Plan of Care dates established?

On the Plan tab of evaluative documents, like in the screenshot below. Review the screenshots to see how Plan of Care dates appear in both SOAP 1.0 and SOAP 2.0.

SOAP 1.0

SOAP 2.0

Note: These date fields are only visible for specific insurance types such as Medicare.

How can I enforce the 90-day POC Federal Medicare requirement for my providers?

You can help your providers to comply with the Federal Medicare 90-day plan of Care requirements by using the Medicare Plan of Care Enforcement Company setting.

These requirements include the need to establish new Plan of Care dates to continue treating and billing for visits dated beyond the POC end date. Checking this setting will prevent the finalization of any Daily Notes with a Date of Service either:

  • Outside of the most recent certification period (if less than 90 days).
  • 90 days beyond the Plan of Care Start Date.
Note: It is not recommended to use this setting if you treat state-level Medicare patients since State Medicare requirements may not follow the same rules.

Medicare defaults to a 90-day POC; so why are you making me do this now?

When completing an evaluation, the therapist establishes the plan of care dates. SOAP 1.0 defaults the plan to four weeks. Therapists can adjust the POC range out to 12 weeks by clicking the drop-down next to the duration on the Plan tab. The screenshots below illustrate the steps to follow.

SOAP 1.0

The date range defaults to four weeks. The duration can be changed by clicking the drop-down.

SOAP 2.0

 In SOAP 2.0, the Plan of Care To Date updates dynamically based on the duration selected in the Planned Treatment and Schedule subsection.

We can no longer see patient names on the schedule; why?

We are working on this alert so it doesn’t block the patient's name.  In the meantime, you can choose to remove POC icons from the scheduler. To do so, click Schedule, then Manage Calendars, and finally Clinic Settings. From there, you can then deselect Expired and Expiring POC in the Status Icon Visibility legend. The screenshot below illustrates where this setting is.

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