Physical Therapy/Occupational Therapy/Speech Therapy

Medical Review Therapy Documentation Checklist for Additional Development Request Letters

Refer to the checklist below when preparing your documentation in response to an ADR:

  • Doctor’s orders
  • Certifications/recertifications
  • Initial evaluations
  • Any reevaluations and documentation of medical necessity for reevaluations
  • Any pertinent diagnostic testing and results
  • Therapists’ notes for dates of service
  • Logs/treatment records/encounter sheets indicating: date, time, type and duration to support units billed
  • Plans of treatment, goals, and progress towards goals
  • Progress notes since onset of therapy
  • Any abbreviation keys or acronym keys used
  • Copies of any patient notices given (e.g., ABN)
  • Documentation to support level of supervision requirements met if applicable
  • Documentation to support any other services billed in conjunction with therapy services
  • Documentation of practitioner’s credentials

Reviewed 10/07/2024