Guest guest Posted January 11, 2012 Report Share Posted 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 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 11, 2012 Report Share Posted January 11, 2012 Hi Ah the burning Medicare question. But we need to know more info. Are you a hospital outpatient practice, a CORF, a private practice? That is important because the rules for hospital based practice have recently changed. Second, I can answer for Medicare Part B outpatient PT in private practice. We absolutely do not need a referral, order (or prescription) from a physician. We DO need the following: 1) the patient must be under the care of the physician for the probelm being treated, i.e. they just can't walk off the street and see you unless they have seen a physician for the same problem. That is a minor need. More importantly, what is needed is the signed certification of the plan of care. Once evaluated, you know that a plan of care has to be sent to the physician and that plan of care has required elements. Once it has all those elements (per the Medicare Benefits Policy Manual) and is returned signed by the physician...that is what Medicare requires, not a referral or order. One caveat to this is that some states also have laws requiring orders so you would also need to check on state law. Please also let us know what type of practice you work at so additional info can be provided, if needed. M. Howell, PT. MPT IPTA Payment Specialist Meridian, ID thowell@... 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. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 13, 2012 Report Share Posted 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 22, 2012 Report Share Posted July 22, 2012 Although required in some cases, we have MD's complain all day long regarding getting the POC faxed and asking for it signed. They don't want it and call us to ask for an update when the patient has a return visit even if we just sent the POC. Kind of a double edged sword sometimes... Heidi Billing Manager Lees Summit, MO RE: Re: physician orders Re private or self-insured. I really don't see a need to get a POC signed y the physician when it is not required. I don't think my optometrist / entist / podiatrist / etc. sent a letter to the MD asking for POC ignature. The physician needs to be involved if it impacts his treatment. f not required then I would see no reason to obtain a referral and approval f my POC. A letter of treatment would probably be sent to the physician as professional courtesy. I can understand it's a good marketing tool; but, If I was a physician, I ould 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 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 esign ~ Recruiting Software From: PTManager [mailto:PTManager ] On Behalf f jcohen135 ent: Saturday, July 21, 2012 10:41 AM o: PTManager ubject: Re: physician orders With regards to treating Medicare patients,why would you be concerned about etting a signed plan of care from the physician? Would this increase the ork or difficulty of starting a practice? In my experience, it does not. We ake it our policy to get signed POCs for all of our patients, regardless of nsurance carrier, just to keep the physicians informed of the treatment. Cohen PT, MS obile 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 23, 2012 Report Share Posted 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: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2012 Report Share Posted July 24, 2012 Conditions of Participation for hospitals require all orders be timed and dated. If the physicians that are timing the orders have staff privileges at a hospital, they may just be in that mind set when writing orders. Rick Gawenda, PT President Gawenda Seminars & Consulting, Inc. www.gawendaseminars.com > 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 > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2012 Report Share Posted July 24, 2012 Conditions of Participation for hospitals require all orders be timed and dated. If the physicians that are timing the orders have staff privileges at a hospital, they may just be in that mind set when writing orders. Rick Gawenda, PT President Gawenda Seminars & Consulting, Inc. www.gawendaseminars.com > 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 > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2012 Report Share Posted July 24, 2012 Conditions of Participation for hospitals require all orders be timed and dated. If the physicians that are timing the orders have staff privileges at a hospital, they may just be in that mind set when writing orders. Rick Gawenda, PT President Gawenda Seminars & Consulting, Inc. www.gawendaseminars.com > 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 > > Quote Link to comment Share on other sites More sharing options...
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