Fixing Non-Covered Therapy Visit Warnings

Modified on Fri, May 22 at 10:53 AM

You may see a notification or warning on the scheduler labeled “Non-covered Therapy Visits.” or “Does not meet every 30 day reassessment requirement.” This usually indicates that therapy visits are not following CMS coverage guidelines.

✅ Why This Warning Appears

Per CMS (Medicare) guidelines:

The first therapy visit must always be a therapy evaluation (PT, OT, or ST).
A re-evaluation must be completed on or before the 30th day from the initial evaluation.
Any therapy visits not preceded by a proper eval or timely re-eval are flagged as non-covered.

✅ How to Fix or Prevent This Issue

Go to: Claims/Auth > Chart of Accounts Settings
Check your visit types:
Ensure you have Therapy Evaluation visits defined for:
- PT (Physical Therapy)
- OT (Occupational Therapy)
- ST (Speech Therapy)
If missing:
- Add in the Chart of Accounts and create the appropriate Evaluation Visit (e.g., “PT Eval”).
- Check the box:
  ✅ "Includes Evaluation/Reassessment"
(Optional but recommended): Create a Re-Evaluation Visit Type with the same setup:
- Use a clear name like "PT Re-Eval".
- Also check the Includes Evaluation/Reassessment box.

✅ Best Practice Tip:

Ensure your scheduling team uses the correct Eval and Re-Eval visit types at the right intervals:

Initial Eval: Must always be first.
Re-Eval: Must occur on or before day 30 from the initial eval to keep therapy visits covered.

Synergy's scheduler uses these visit types to calculate compliance and coverage status—incorrect setup or usage can trigger the non-covered warning.

This FAQ was generated based on Synergy AI/EMR App Version 7.0.38.36159 and Dashboards Version: 7.0.38.14741

Important: The information in this FAQ is based on the software version available at the time of publication and is subject to change. Please use the software responsibly. HealthCare Synergy is not liable for any issues resulting from outdated or incorrect use of this information.