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Physical therapists (PTs) and physical therapist assistants (PTAs) know they can't take their eyes off the ball when it comes to properly documenting care. That's why APTA has revamped and updated its collection of online resources supporting defensible documentation.

APTA's retooled webpage includes the latest on best practices in documentation, presented in an easy-to-navigate format. Extensive resources include an overview of the defensible documentation concept, elements of documentation within the patient/client management model, setting-specific considerations, risk management, and additional resources such as publications from the US Centers for Medicare and Medicaid Services (CMS) and relevant articles from PT in Motion magazine.

Also included: tips on defensible documentation and a sample documentation checklist that outlines the process from initial examination and evaluation to completion of the episode of care.

The webpage advises visitors that while the resources offered provide information "as comprehensive as APTA can reasonably make it," PTs and PTAs also need to check specific compliance requirements of payers, state laws, third-party administrators, and other organizations.

 


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