Medicare question

[Guest guest]

I have this situation: A rural health clinic has an M.D. medical director

that is not there every day. Staff is primarily LPN's and PA-C's. Patient

comes in to my clinic telling me that their " doctor " is one of the LPN's. 2

months ago the patient went to see the LPN and was referred to PT. For

various reasons the patient held on to the script for 2 months and then

called to schedule. I told her that too much time had gone by and that she

should schedule another appointment with her " doctor " since so much time had

gone by. She did; the LPN wasn't available this time around so she was seen

by the by the M.D. who filled out a new script with the identical wording as

the initial script by the LPN for PT. I send the Eval to the MD and am told

that it this isn't their patient and to send it to the LPN. If I send the

Plan of Care to the LPN as the referring provider and she signs it do I

still need a new script from the LPN...This is a Medicare patient.

Another question: Can a " non M.D. " provider refer a Medicare patient for

outpatient PT?

Just talked with my intermediary and was told that only an M.D. is

authorized to refer a Medicare beneficiary for outpatient PT???

Jeff LePage, PT

First Choice Physical Therapy

Wasilla, Alaska

[Guest guest]

Jeff -

Thanks for bring this question up!

1) An LPN/LVN is not a person who may sign/certify a Medicare Plan of

Care (POC). Traditionally, an LPN/LVN is not one who may refer to PT,

however, in the vast majority of the nation, anyone may refer to PT, because

even a self-referral leads to an evaluative process. Caveat: I acknowledge

that there are some States and circumstances where direct access to physical

therapists is still denied to the citizenry.

2) Pending passage of the Medicare Access to Physical Therapist Act, an

MD/DO, ARNP, or PA is the only authorized professional who may sign/certify

a POC. While an LPN may suggest to an authorized professional that a

patient be referred to you, the LPNs " prescription " is probably not one that

your practice act permits. These folks have -- maybe -- half the education

of an LPTA.

Hope that helps,

Dick Hillyer, PT, DPT, MBA,MSM

Dr. W. Hillyer

Hillyer Consulting

700 El Dorado Pkwy W.

Cape Coral, FL 33914

Home

Office

Mobile

_____

From: PTManager [mailto:PTManager ] On Behalf

Of Jeff LePage

Sent: Friday, January 11, 2008 2:01 PM

To: ptmanager

Subject: Medicare question

I have this situation: A rural health clinic has an M.D. medical director

that is not there every day. Staff is primarily LPN's and PA-C's. Patient

comes in to my clinic telling me that their " doctor " is one of the LPN's. 2

months ago the patient went to see the LPN and was referred to PT. For

various reasons the patient held on to the script for 2 months and then

called to schedule. I told her that too much time had gone by and that she

should schedule another appointment with her " doctor " since so much time had

gone by. She did; the LPN wasn't available this time around so she was seen

by the by the M.D. who filled out a new script with the identical wording as

the initial script by the LPN for PT. I send the Eval to the MD and am told

that it this isn't their patient and to send it to the LPN. If I send the

Plan of Care to the LPN as the referring provider and she signs it do I

still need a new script from the LPN...This is a Medicare patient.

Another question: Can a " non M.D. " provider refer a Medicare patient for

outpatient PT?

Just talked with my intermediary and was told that only an M.D. is

authorized to refer a Medicare beneficiary for outpatient PT???

Jeff LePage, PT

First Choice Physical Therapy

Wasilla, Alaska