Can case manager deny therapy?

  1. I am currently working with a home health agency in Texas. An active patient was approved for 16 Physical therapy visits for the current Medicare episode but her case manager decided she didn't want her to have therapy at this time. Because of that physical therapy is not going to happen. Can the case manager make this decision? I feel appropriateness of care should be determined by a Physical therapist.
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  2. 3 Comments

  3. by   dianah
    Moved to Case Management Nursing forum.
  4. by   oceanblue52
    I'm not Case Manager certified, but I did work as one in Home Health in Colorado. This was not our decision to make, PT/OT were always scheduled separately and they did their own assessment. Perhaps it varies by state?
  5. by   KelRN215
    Was Physical Therapy ordered by the MD? If yes and approved, I don't understand why the Case Manager "wouldn't want" the patient to have PT.

    Medicare is a federal program. Guidelines don't vary by state.

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