Re: outpatient referrals by nonstaff MDs

January 12, 2012

The producers of this transmittal were clearly thinking about inpatient, not

outpatient, services.

What we have here at base is invent a system that has become complicated beyond

our ability to handle it. Follow the path of that transmittal... Broadly written

laws were handed from the legislature to an army of bureaucrats who produced

thousands of pages of interpretations. That mess, often clear as mud, induced

other bureaucrats to produce interpretations of the interpretations, like this

transmittal. Interpretations of the interpretations of the interpretations are

then applied by inspectors, and of course by those targeted by the rules (us).

The entire tangle of ideas is given the weight of law. Craziness.

________________________________

From: PTManager [mailto:PTManager ] On Behalf Of

,

Sent: Wednesday, January 11, 2012 1:42 PM

To: PTManager

Subject: outpatient referrals by nonstaff MDs

Good afternoon for those practicing in hospitals that see outpatients how is the

new CMS interpretations affecting you if the doctor is not on staff of the

hospital they can no longer refer to the hospital. I copied the language and the

link below it was effective November 18, 2011.

http://www.cms.gov/transmittals/downloads/R72SOM.pdf

§482.56( Standard: Delivery of Services

Services must only be provided under the orders of a qualified and licensed

practitioner who is responsible for the care of the patient, acting within his

or her scope of practice under State law, and who is authorized by the

hospital's medical staff to order the services in accordance with hospital

policies and procedures and State laws.

Interpretive Guidelines §482.56(

Rehabilitation services must be ordered by a qualified and licensed practitioner

who is responsible for the care of the patient. The practitioner must have

medical staff privileges to write orders for these services. Privileges must be

granted in a manner consistent with the State's scope of practice law, as well

as with hospital policies and procedures governing rehabilitation services

developed by the medical staff and approved by the governing body. Practitioners

who may be granted privileges to order rehabilitation services include

physicians, and may also, in accordance with hospital policy, be extended to

Nurse Practitioners, Physicians' Assistants, and Clinical Nurse Specialists as

long as they meet the parameters of this requirement. Although the following

licensed professionals are also considered " practitioners " in accordance with

Section 1842((18)© of the Social Security Act, they generally would not be

considered responsible for the care of the patient or qualified to order

rehabilitation services: Certified registered nurse anesthetist (Section

1861(bb)(2) of the Act); Certified nurse-midwife (Section 1861(gg)(2) of the

Act); Clinical social worker (Section 1861(hh)(1) of the Act); Clinical

psychologist (for purposes of Section 1861(ii) of the Act and as defined at 42

CFR 410.71); or registered dietician or nutrition professional.

L. , PT, DPT, MBA

Director, Physical Rehabilitation Services

East Orange General Hospital

phone

fax

pager

" An ounce of prevention is worth a pound of cure. "

__________________________________________________________

IMPORTANT: This message contains confidential information and is intended only

for the individual(s) named.

If you are not the named addressee, you are not authorized (either explicitly or

implicitly) to disseminate,

distribute or copy this e-mail in any manner whatsoever. Please notify the

sender immediately by e-mail if you

received this e-mail in error and delete this e-mail from your system.

Unintended transmission shall not

constitute waiver of the attorney-client or any other applicable privilege.

E-mail transmission cannot be

guaranteed to be secure or error-free as information could be intercepted,

corrupted, lost, destroyed, arrive

late or incomplete, or contain viruses. The sender therefore does not accept

liability for any errors or omissions

in the contents of this message, which arise as a result of e-mail transmission.

________________________________

Confidentiality Note: The information contained in this electronic message is

privileged and confidential information intended for the use of the individual

or entity named above. If you are not the intended recipient, you are hereby

notified that any dissemination, distribution, or copy of this message is

strictly prohibited. If you have received this electronic message in error,

please delete the message immediately and notify us by telephone. Thank you.

January 12, 2012

and Group,

My interpretation of this portion of the CMS manual is that this applies to

Medicare Part A which encompasses in-patients in the hospital rather than

out-patients. If this were to apply to out-patients it would severely alter

the way every hospital based out-patient clinic that I know of (including mine)

does business.

This is the first Iâ€™ve seen this particular document. Previous coverage

determinations applicable to out-patients have never limited referrals to

hospital providers and have allowed the therapist to establish the POC and that

the referring provider must only certify the POC.

I hope this helps. Anyone else have input on this?

Chad Yoakam

Livingston HealthCare