Physician orders

January 11, 2012

I have been told at various seminars that Medicare does not require physician

orders to proceed with and be reimbursed for PT/OT/ST. Our company requires

orders as a policy. In Ohio, we have direct access, but there are still

questions as to whether our services are reimburseable by Medicare if there are

no orders. Does anyone have specific knowledge of this issue?

Wendland PT

Ohio

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Dedicated to Hope, Healing and Recovery.

January 13, 2012

Under outpatient Medicare part B CMS rules and regulations, a physician order is

not required for payment. What is required is a signed and dated plan of care. A

physician order can prove the patient was under the care of a physician or NPP

in case the plan of care was not signed timely.

You also have to look at the Conditions of Participation based on your practice

setting for Medicare. For example, in the CoP for hospitals, it states orders

are required. Hope this helps.

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc.

www.gawendaseminars.com

Follow Gawenda Seminars & Consulting, Inc on Facebook

Register for January 24, 2012 audio conference " 2012 Medicare & Private Payor

Updates " at

https://www.showmyevent.com/events/viewEventDetails.aspx?EventID=1735

Subject: Physician orders

To: " 'board@...' " , " 'consumer@...' "

, " 'ptmanager ' " <ptmanager >,

" 'geriatricspt ' " <geriatricspt >

Date: Wednesday, January 11, 2012, 11:27 AM

Â

I have been told at various seminars that Medicare does not require

physician orders to proceed with and be reimbursed for PT/OT/ST. Our company

requires orders as a policy. In Ohio, we have direct access, but there are

still questions as to whether our services are reimburseable by Medicare if

there are no orders. Does anyone have specific knowledge of this issue?

Wendland PT

Ohio

The information contained in this E-mail transmission is

intended only for the use of the individual or entity to whom

it is addressed. It may contain privileged, confidential,

and protected health information.

If you received it in error, you are on notice of its status.

Please notify us immediately by reply e-mail and then please

delete this message from your system. Please do not copy it

or use it for any purposes, or disclose its contents to any

other person. To do so could violate state and Federal

privacy laws. Thank you for your cooperation.

Please contact the sender if you need assistance.

Dedicated to Hope, Healing and Recovery.

January 13, 2012

Under outpatient Medicare part B CMS rules and regulations, a physician order is

not required for payment. What is required is a signed and dated plan of care. A

physician order can prove the patient was under the care of a physician or NPP

in case the plan of care was not signed timely.

You also have to look at the Conditions of Participation based on your practice

setting for Medicare. For example, in the CoP for hospitals, it states orders

are required. Hope this helps.

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc.

www.gawendaseminars.com

Follow Gawenda Seminars & Consulting, Inc on Facebook

Register for January 24, 2012 audio conference " 2012 Medicare & Private Payor

Updates " at

https://www.showmyevent.com/events/viewEventDetails.aspx?EventID=1735

Subject: Physician orders

To: " 'board@...' " , " 'consumer@...' "

, " 'ptmanager ' " <ptmanager >,

" 'geriatricspt ' " <geriatricspt >

Date: Wednesday, January 11, 2012, 11:27 AM

Â

I have been told at various seminars that Medicare does not require

physician orders to proceed with and be reimbursed for PT/OT/ST. Our company

requires orders as a policy. In Ohio, we have direct access, but there are

still questions as to whether our services are reimburseable by Medicare if

there are no orders. Does anyone have specific knowledge of this issue?

Wendland PT

Ohio

The information contained in this E-mail transmission is

intended only for the use of the individual or entity to whom

it is addressed. It may contain privileged, confidential,

and protected health information.

If you received it in error, you are on notice of its status.

Please notify us immediately by reply e-mail and then please

delete this message from your system. Please do not copy it

or use it for any purposes, or disclose its contents to any

other person. To do so could violate state and Federal

privacy laws. Thank you for your cooperation.

Please contact the sender if you need assistance.

Dedicated to Hope, Healing and Recovery.

July 23, 2012

I agree with Steve

We send POC's to all physicians as a COURTESY, but only require a signature

for the Medicare requirments.....as any other provider sends to their

referral source. I don't want to bother them for more signatures, hate that

we have to do it all with Medicare.

This gets to the following point again.......as long as we feel we HAVE to

have a signature from ALL DOCS, then that just delays are INDEPENDENCE all

together. Requires us to be DEPENDENT of them, vs. INDEPENDENT. And, THEY

ALL HATE, having all the paperwork come across their desk.

Kevyn Soupiset, PT, MPT

Progressive Therapy & Sports Medicine

117 W. 6th

Larned, KS 67550

Ph: Fax

From: PTManager [mailto:PTManager ] On Behalf

Of Steve Passmore

Sent: Sunday, July 22, 2012 3:29 PM

To: PTManager

Subject: RE: Re: physician orders

Re private or self-insured. I really don't see a need to get a POC signed

by the physician when it is not required. I don't think my optometrist /

dentist / podiatrist / etc. sent a letter to the MD asking for POC

signature. The physician needs to be involved if it impacts his treatment.

If not required then I would see no reason to obtain a referral and approval

of my POC. A letter of treatment would probably be sent to the physician as

a professional courtesy.

I can understand it's a good marketing tool; but, If I was a physician, I

would not want to sign a POC for something I did not order.

Am I being too much of a rebel?

Steve Passmore PT, MS (soon to be DPT)

Healthy Recruiting Tools

<mailto:spass@... <mailto:spass%40healthyrecruiting.com> >

spass@... <mailto:spass%40healthyrecruiting.com>

Phone:

Fax:

" What We Did For You Yesterday is History. What Can We Do For You Today "

Recruiting Tools: Cold Calls ~ List Enhancement ~ Direct Mailers ~ Card

Design ~ Recruiting Software

From: PTManager <mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com> ] On

Behalf

Of jcohen135

Sent: Saturday, July 21, 2012 10:41 AM

To: PTManager <mailto:PTManager%40yahoogroups.com>

Subject: Re: physician orders

With regards to treating Medicare patients,why would you be concerned about

getting a signed plan of care from the physician? Would this increase the

work or difficulty of starting a practice? In my experience, it does not. We

make it our policy to get signed POCs for all of our patients, regardless of

insurance carrier, just to keep the physicians informed of the treatment.

Cohen PT, MS

Mobile Rehab NC

>

> I am thinking about starting a private practice on the side. I realize

> Medicare patients would need physician referral but wonder what percentage

> of private insurances require MD orders. We have practice without referral

> in this state and I would anticipate most patients to be BC or something

> like that. Possibly some champus as this is a large retirement area.

>

> Steve Passmore PT, MS (soon to be DPT)

>

> Healthy Recruiting Tools

>

> spass@...

>

> Phone:

>

> Fax:

>

> " What We Did For You Yesterday is History. What Can We Do For You Today "

>

> Recruiting Tools: Cold Calls ~ List Enhancement ~ Direct Mailers ~ Card

> Design ~ Recruiting Software

>

July 23, 2012

I agree with Steve

We send POC's to all physicians as a COURTESY, but only require a signature

for the Medicare requirments.....as any other provider sends to their

referral source. I don't want to bother them for more signatures, hate that

we have to do it all with Medicare.

This gets to the following point again.......as long as we feel we HAVE to

have a signature from ALL DOCS, then that just delays are INDEPENDENCE all

together. Requires us to be DEPENDENT of them, vs. INDEPENDENT. And, THEY

ALL HATE, having all the paperwork come across their desk.

Kevyn Soupiset, PT, MPT

Progressive Therapy & Sports Medicine

117 W. 6th

Larned, KS 67550

Ph: Fax

From: PTManager [mailto:PTManager ] On Behalf

Of Steve Passmore

Sent: Sunday, July 22, 2012 3:29 PM

To: PTManager

Subject: RE: Re: physician orders

Re private or self-insured. I really don't see a need to get a POC signed

by the physician when it is not required. I don't think my optometrist /

dentist / podiatrist / etc. sent a letter to the MD asking for POC

signature. The physician needs to be involved if it impacts his treatment.

If not required then I would see no reason to obtain a referral and approval

of my POC. A letter of treatment would probably be sent to the physician as

a professional courtesy.

I can understand it's a good marketing tool; but, If I was a physician, I

would not want to sign a POC for something I did not order.

Am I being too much of a rebel?

Steve Passmore PT, MS (soon to be DPT)

Healthy Recruiting Tools

<mailto:spass@... <mailto:spass%40healthyrecruiting.com> >

spass@... <mailto:spass%40healthyrecruiting.com>

Phone:

Fax:

" What We Did For You Yesterday is History. What Can We Do For You Today "

Recruiting Tools: Cold Calls ~ List Enhancement ~ Direct Mailers ~ Card

Design ~ Recruiting Software

From: PTManager <mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com> ] On

Behalf

Of jcohen135

Sent: Saturday, July 21, 2012 10:41 AM

To: PTManager <mailto:PTManager%40yahoogroups.com>

Subject: Re: physician orders

With regards to treating Medicare patients,why would you be concerned about

getting a signed plan of care from the physician? Would this increase the

work or difficulty of starting a practice? In my experience, it does not. We

make it our policy to get signed POCs for all of our patients, regardless of

insurance carrier, just to keep the physicians informed of the treatment.

Cohen PT, MS

Mobile Rehab NC

>

> I am thinking about starting a private practice on the side. I realize

> Medicare patients would need physician referral but wonder what percentage

> of private insurances require MD orders. We have practice without referral

> in this state and I would anticipate most patients to be BC or something

> like that. Possibly some champus as this is a large retirement area.

>

> Steve Passmore PT, MS (soon to be DPT)

>

> Healthy Recruiting Tools

>

> spass@...

>

> Phone:

>

> Fax:

>

> " What We Did For You Yesterday is History. What Can We Do For You Today "

>

> Recruiting Tools: Cold Calls ~ List Enhancement ~ Direct Mailers ~ Card

> Design ~ Recruiting Software

>

July 23, 2012

I agree with Steve

We send POC's to all physicians as a COURTESY, but only require a signature

for the Medicare requirments.....as any other provider sends to their

referral source. I don't want to bother them for more signatures, hate that

we have to do it all with Medicare.

This gets to the following point again.......as long as we feel we HAVE to

have a signature from ALL DOCS, then that just delays are INDEPENDENCE all

together. Requires us to be DEPENDENT of them, vs. INDEPENDENT. And, THEY

ALL HATE, having all the paperwork come across their desk.

Kevyn Soupiset, PT, MPT

Progressive Therapy & Sports Medicine

117 W. 6th

Larned, KS 67550

Ph: Fax

From: PTManager [mailto:PTManager ] On Behalf

Of Steve Passmore

Sent: Sunday, July 22, 2012 3:29 PM

To: PTManager

Subject: RE: Re: physician orders

Re private or self-insured. I really don't see a need to get a POC signed

by the physician when it is not required. I don't think my optometrist /

dentist / podiatrist / etc. sent a letter to the MD asking for POC

signature. The physician needs to be involved if it impacts his treatment.

If not required then I would see no reason to obtain a referral and approval

of my POC. A letter of treatment would probably be sent to the physician as

a professional courtesy.

I can understand it's a good marketing tool; but, If I was a physician, I

would not want to sign a POC for something I did not order.

Am I being too much of a rebel?

Steve Passmore PT, MS (soon to be DPT)

Healthy Recruiting Tools

<mailto:spass@... <mailto:spass%40healthyrecruiting.com> >

spass@... <mailto:spass%40healthyrecruiting.com>

Phone:

Fax:

" What We Did For You Yesterday is History. What Can We Do For You Today "

Recruiting Tools: Cold Calls ~ List Enhancement ~ Direct Mailers ~ Card

Design ~ Recruiting Software

From: PTManager <mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com> ] On

Behalf

Of jcohen135

Sent: Saturday, July 21, 2012 10:41 AM

To: PTManager <mailto:PTManager%40yahoogroups.com>

Subject: Re: physician orders

With regards to treating Medicare patients,why would you be concerned about

getting a signed plan of care from the physician? Would this increase the

work or difficulty of starting a practice? In my experience, it does not. We

make it our policy to get signed POCs for all of our patients, regardless of

insurance carrier, just to keep the physicians informed of the treatment.

Cohen PT, MS

Mobile Rehab NC

>

> I am thinking about starting a private practice on the side. I realize

> Medicare patients would need physician referral but wonder what percentage

> of private insurances require MD orders. We have practice without referral

> in this state and I would anticipate most patients to be BC or something

> like that. Possibly some champus as this is a large retirement area.

>

> Steve Passmore PT, MS (soon to be DPT)

>

> Healthy Recruiting Tools

>

> spass@...

>

> Phone:

>

> Fax:

>

> " What We Did For You Yesterday is History. What Can We Do For You Today "

>

> Recruiting Tools: Cold Calls ~ List Enhancement ~ Direct Mailers ~ Card

> Design ~ Recruiting Software

>

July 23, 2012

Rick,

I am seeing some physicians timing their signatures on the plan of care. Is

this a requirement that I have not heard about?

Matt Dvorak, PT

Peloton Physical Therapy

Yankton, SD

From: PTManager [mailto:PTManager ] On Behalf Of

Rick Gawenda

Sent: Friday, July 20, 2012 7:43 PM

To: PTManager

Subject: Re: physician orders

Just to clarify, the Medicare program does not require a physician referral,

rather, a signed and dated plan of care.

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc.

http://www.gawendaseminars.com

On Jul 20, 2012, at 3:37 PM, " Steve Passmore " <spass@...

<mailto:spass%40HealthyRecruiting.com> > wrote:

> I am thinking about starting a private practice on the side. I realize

> Medicare patients would need physician referral but wonder what percentage

> of private insurances require MD orders. We have practice without referral

> in this state and I would anticipate most patients to be BC or something

> like that. Possibly some champus as this is a large retirement area.

>

> Steve Passmore PT, MS (soon to be DPT)

>

> Healthy Recruiting Tools

>

> spass@... <mailto:spass%40healthyrecruiting.com>

>

> Phone:

>

> Fax:

>

> " What We Did For You Yesterday is History. What Can We Do For You Today "

>

> Recruiting Tools: Cold Calls ~ List Enhancement ~ Direct Mailers ~ Card

> Design ~ Recruiting Software

>

July 23, 2012

Rick,

I am seeing some physicians timing their signatures on the plan of care. Is

this a requirement that I have not heard about?

Matt Dvorak, PT

Peloton Physical Therapy

Yankton, SD

From: PTManager [mailto:PTManager ] On Behalf Of

Rick Gawenda

Sent: Friday, July 20, 2012 7:43 PM

To: PTManager

Subject: Re: physician orders

Just to clarify, the Medicare program does not require a physician referral,

rather, a signed and dated plan of care.

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc.

http://www.gawendaseminars.com

On Jul 20, 2012, at 3:37 PM, " Steve Passmore " <spass@...

<mailto:spass%40HealthyRecruiting.com> > wrote:

> I am thinking about starting a private practice on the side. I realize

> Medicare patients would need physician referral but wonder what percentage

> of private insurances require MD orders. We have practice without referral

> in this state and I would anticipate most patients to be BC or something

> like that. Possibly some champus as this is a large retirement area.

>

> Steve Passmore PT, MS (soon to be DPT)

>

> Healthy Recruiting Tools

>

> spass@... <mailto:spass%40healthyrecruiting.com>

>

> Phone:

>

> Fax:

>

> " What We Did For You Yesterday is History. What Can We Do For You Today "

>

> Recruiting Tools: Cold Calls ~ List Enhancement ~ Direct Mailers ~ Card

> Design ~ Recruiting Software

>

July 23, 2012

Rick,

I am seeing some physicians timing their signatures on the plan of care. Is

this a requirement that I have not heard about?

Matt Dvorak, PT

Peloton Physical Therapy

Yankton, SD

From: PTManager [mailto:PTManager ] On Behalf Of

Rick Gawenda

Sent: Friday, July 20, 2012 7:43 PM

To: PTManager

Subject: Re: physician orders

Just to clarify, the Medicare program does not require a physician referral,

rather, a signed and dated plan of care.

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc.

http://www.gawendaseminars.com

On Jul 20, 2012, at 3:37 PM, " Steve Passmore " <spass@...

<mailto:spass%40HealthyRecruiting.com> > wrote:

> I am thinking about starting a private practice on the side. I realize

> Medicare patients would need physician referral but wonder what percentage

> of private insurances require MD orders. We have practice without referral

> in this state and I would anticipate most patients to be BC or something

> like that. Possibly some champus as this is a large retirement area.

>

> Steve Passmore PT, MS (soon to be DPT)

>

> Healthy Recruiting Tools

>

> spass@... <mailto:spass%40healthyrecruiting.com>

>

> Phone:

>

> Fax:

>

> " What We Did For You Yesterday is History. What Can We Do For You Today "

>

> Recruiting Tools: Cold Calls ~ List Enhancement ~ Direct Mailers ~ Card

> Design ~ Recruiting Software

>

July 23, 2012

Steve and Mark,

Much of that depends on the state and the particular contract-plan that

the insurers purchase. When we got direct access in CT a few years

ago--the insurance companies were the ones that wanted the DA bill

defeated. Hence, in CT many of the insurance companies now require a

referral (United Healthcare, Aetna, etc.). The big issuen however, has

been that electronic billing requires a physician NPI otherwise it is

kicked out. So those claims for DA now have to be dropped to paper and

it slows the reimbursement process. Have you found a way around this

issue that we haven't thought of or tried? I am all ears if that is the

case.

Peg

Peg Grey, PT, DPT, MA, OCS, ATC

Grey Physical Therapy & Sports Medicine

Personalized Conditioning by Grey

101 Phoenix Avenue

Suite 2D

Enfield, CT 06082

Phone:

Fax:

E-mail: pegg@...

Body Made Better by Grey. . . a tradition of caring since 1984

Steve,

We got limited direct access in Kansas in 2007 and we began using it in

my hospital in 2008. We have not had any problems getting reimbursed as

we have no commercial insurers that require a referral. Many others I

talked to in other direct access states at that time told me they had no

commercial insurers that required a referral either. They challenged me

to read my insurer contracts and read the insurer's policies, which I

did, and I found they were right. None of our 30+ contracts had any

language about referrals, and neither did their claims submission

policies (that was fun reading all of those, let me tell ya').

Like Rick said, Medicare Part B doesn't require a physician referral but

instead a signed plan of care. So if you have some strong physician

relationships you may be able to work out ahead of time with them that

you can see their patients without a referral and they will still sign

the POC, giving you semi-direct access with those physicians.

Mark Dwyer, PT, MHA

Director of Rehabilitation Services

Olathe Medical Center

Olathe, Kansas

markdwyer87@...

<javascript:parent.wgMail.openComposeWindow('markdwyer87@...')>

4aphysician orders

Fri Jul 20, 2012 3:53 pm (PDT) . Posted by: " Steve Passmore " steve2uu_99I

am thinking about starting a private practice on the side. I realize

Medicare patients would need physician referral but wonder what

percentage

of private insurances require MD orders. We have practice without

referral

in this state and I would anticipate most patients to be BC or something

like that. Possibly some champus as this is a large retirement area.

Steve Passmore PT, MS (soon to be DPT)

Healthy Recruiting Tools

spass@...

<javascript:parent.wgMail.openComposeWindow('spass@...')>

Phone:

Fax:

July 23, 2012