Frequency and Duration

March 28, 2012

Looking for advice. Does anyone else have issues with treatments exceeding

ordered duration due to delays in obtaining pre-authorization? If so, how do you

write your plan of care to ensure that all visits will be covered? We are a

joint commission certified hospital based provider.

Here is an example:

The doctor writes work comp order for PT daily x 1 week. The therapist sees

patient for initial evaluation on a Monday and submits paperwork for

pre-authorization of additional visits. Pre-auth takes 3 days so the therapist

sees the patient again on Friday but has now only seen the patient twice. The

therapist needs to see the patient Mon-Wed of the following week to complete 5

visits before the patient returns to MD but the ordered duration (1 week) has

been exceeded. We do not want to have to contact the doctor for updated orders

each time this occurs which seems to be frequently.

Here are options we have considered writing on our plan of care. We develop a

written plan of care that we get signed by the MD for every patient. This POC

then serves as the revised order.

1) Write " daily x 2 weeks " even though the original order is for 1 week.

2) Write " daily x 2 weeks (5 visits total) "

3) Write " daily x 1-2 weeks " (range order, is this acceptable?)

4) Write " daily times 1 week beginning upon receipt of pre-auth " . (Not approved

by our compliance department because it appears to link treatment plan with

payment.)

Comments and suggestions welcome.

Thanks

March 28, 2012

I would suggest that you define treatment parameters in your POC

including interventions, frequency and duration. If you have a working

relationship with the MD/DO/LMP suggest they send orders simply for eval

and treat and allow therapist to determine appropriate intervention

intervals. I would also suggest that you contact the payers and tell

them that you need a shorter approval timeline. With work comp , engage

the company and the patient - they need customers as much as you do.

Three day wait for approval on a WC is unacceptable IMHO

Ron Barbato PT

Administrative Director, Rehabilitation Services

Program Director, Cancer Support Services

Ephraim McDowell Health

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rbarbato@...

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Frequency and Duration

Looking for advice. Does anyone else have issues with treatments

exceeding ordered duration due to delays in obtaining pre-authorization?

If so, how do you write your plan of care to ensure that all visits will

be covered? We are a joint commission certified hospital based provider.

Here is an example:

The doctor writes work comp order for PT daily x 1 week. The therapist

sees patient for initial evaluation on a Monday and submits paperwork

for pre-authorization of additional visits. Pre-auth takes 3 days so the

therapist sees the patient again on Friday but has now only seen the

patient twice. The therapist needs to see the patient Mon-Wed of the

following week to complete 5 visits before the patient returns to MD but

the ordered duration (1 week) has been exceeded. We do not want to have

to contact the doctor for updated orders each time this occurs which

seems to be frequently.

Here are options we have considered writing on our plan of care. We

develop a written plan of care that we get signed by the MD for every

patient. This POC then serves as the revised order.

1) Write " daily x 2 weeks " even though the original order is for 1 week.

2) Write " daily x 2 weeks (5 visits total) "

3) Write " daily x 1-2 weeks " (range order, is this acceptable?)

4) Write " daily times 1 week beginning upon receipt of pre-auth " . (Not

approved by our compliance department because it appears to link

treatment plan with payment.)

Comments and suggestions welcome.

Thanks

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March 28, 2012