What happens if a patient receives more than 25 percent of their therapy in a concurrent/group setting?



The provider will receive a warning edit on the validation report that will inform them that they have exceeded the 25% limit. The edit will state: “The total number of group and/or concurrent minutes for one or more therapy disciplines exceeds the 25 percent limit on concurrent and group therapy. Consistent violation of this limit may result in your facility being flagged for additional medical review.” CMS will also monitor provision and be aware of facilities that exceed the limit and will re-visit the idea of a penalty for exceeding the limit in the future.


Answer by Jessica Cairns, RN, RAC-CT, CMAC
Clinical Consultant

Click here to learn more about the rest of the Proactive team.