Guest guest Posted August 26, 2004 Report Share Posted August 26, 2004 Jill - There are those who hold that the concept of a " script " or " prescription " , or " order " does not exist in either Medicare or the APTA Guide to Practice. I'm speaking of IP/OP services. I believe that in SNFs and some other areas, the concept of an " order " may still linger. Unfortunately, no one seems to have told the docs about the PT being a referral, rather than a prescriptive relationship(!) ...or they're in denial. The concept is that a Plan of Care is prepared *after* consultation with the appropriate therapist. We treat a " prescription " as the ticket to the evaluation, after which the POC is prepared. It must be re-certified every 30 days, and the patient must be actually " seen " at 60, then 30 days. The POC, not a " prescription " , is the driving document. Some office managers who " don't get it " still insist that there be a " prescription " , but they're retiring soon. Dick Hillyer Cape Coral / Ft. Myers, FL --Original Message----- From: Jill Piazza Sent: Wednesday, August 25, 2004 9:42 PM To: PT manager Subject: Scripts vs. POC's Hello list, For medicare outpatients, can the signed POC substitute for a script being signed every 30 days or must you get both? The problem we are having in some cases is that we get the POC back signed, but the script expired and the doc hasn't sent it back yet with a signature. If the POC is up to date and signed by the MD, couldn't this suffice? Jill Piazza, PT, MSPT Florida Hospital DeLand Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2004 Report Share Posted August 26, 2004 I'll take Dick's point a step further. There are many instances where a " prescription " , without an authorized POC, can actually INCREASE the risks for non-compliance, as well as destroy a malpractice defense. What matters most are: the patients' clinical presentation & our findings, not " orders " . Despite the wishes of some physician colleagues, we don't take orders unless we are in the military. I know this is almost blasphemy, but c'est la vie. The day will soon come when such MD authorization is no longer required. Are we ready? Ken Mailly, PT Mailly & Inglett Consulting, LLC Tel. 973 692-0033 Fax 973 633-9557 68 Seneca Trail Wayne, NJ, 07470 www.NJPTAid.biz Bridging the Gap! Confidentiality Note: This electronic mail is a communication from M & I Consulting that may be privileged, confidential or otherwise protected from disclosure. This information contained herein, is intended to be for the addressee only. The authorized recipient of this information is prohibited from disclosing this information to any other party and is required to destroy the information after its stated need has been fulfilled. If you are not the addressee, any disclosure, copy, distribution or action taken in reliance on the contents of this electronic mail is strictly prohibited. If you have received this electronic mail in error, please notify the sender immediately. Scripts vs. POC's Hello list, For medicare outpatients, can the signed POC substitute for a script being signed every 30 days or must you get both? The problem we are having in some cases is that we get the POC back signed, but the script expired and the doc hasn't sent it back yet with a signature. If the POC is up to date and signed by the MD, couldn't this suffice? Jill Piazza, PT, MSPT Florida Hospital DeLand Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 27, 2004 Report Share Posted August 27, 2004 Hello Jill - I read the responses you have received so far, and I'd like to add a comment. In Michigan, a " prescription " is required to start the care (based on our state practice act). Medicare additionally requires the signed POC/certification. Most certs have all of the elements in them that are required by our state practice act to meet the definition of a prescription. However, we have had the unfortunate experience of being under Medicare review about two years ago, and UGS disagreed with our argument. They denied any claims we had that did not have both a " prescription " and a signed cert to cover all dates of service. Our appeals failed. There is a distinction between what is required by law for the PT to provide the care, and what a 3rd party payor requires for you to be reimbursed for that work. Sometimes the FI's interpret the Medicare requirements a little differently. We stopped fighting the battle, and gave UGS what they wanted - both a scrip and a signed cert each 30 days. It wasn't worth risking the rejections. We have been off review for almost two years, and now have an excellent reimbursment rate with Medicare. While we were on review, one of the issues they singled us out for was rejections on care that extended into a second 30-day cycle. UGS said that if we rely soley on the recertification to come back (in lieu of a prescription to continue care), any visits that ocurred between the time the 1st cert ended and the date the 2nd cert was actually signed by the physician, would not be paid. We had to have either an actual scrip from the doctor dated no later that the first date we began treatment in the next billing cycle, or a note in the chart that said " phone order received by Dr. X to continue care, scrip to follow " . When it arrives, that scrip must be dated correctly even if you receive it a week later. We lost several thousands of dollars over this issue. I don't know if UGS is interpreting the intention of the Medicare law correctly or not, but I strongly suggest you talk with your FI's claims review representative to determine his/her understanding of the scrip/cert issues. That interpretation is the only one that truly counts if you are concerned about being paid. Hope that helps. Kim Beauchamp Manager, Outpatient Rehab Services St. ph's Mercy of Macomb beauchak@... > Hello list, > For medicare outpatients, can the signed POC substitute for a script being signed every 30 days or must you get both? > The problem we are having in some cases is that we get the POC back signed, but the script expired and the doc hasn't sent it back yet with a signature. If the POC is up to date and signed by the MD, couldn't this suffice? > Jill Piazza, PT, MSPT > Florida Hospital DeLand > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 9, 2004 Report Share Posted September 9, 2004 Dick you wrote " We treat a " prescription " as the ticket to the evaluation, after which the POC is prepared. It must be re-certified every 30 days, and the patient must be actually " seen " at 60, then 30 days " . What is it the POC or the prescription. Is it the POC that needs to be recertified every 30 days or the prescription that needs to be recertified every 30 days. Carol Sangi,PT Director,Therapy Services Bayonne Medical Center 29 East 29 Street Bayonne NJ 07002 Fax: E-mail: csangi@... Scripts vs. POC's Hello list, For medicare outpatients, can the signed POC substitute for a script being signed every 30 days or must you get both? The problem we are having in some cases is that we get the POC back signed, but the script expired and the doc hasn't sent it back yet with a signature. If the POC is up to date and signed by the MD, couldn't this suffice? Jill Piazza, PT, MSPT Florida Hospital DeLand Quote Link to comment Share on other sites More sharing options...
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