Re: Certification - challenge = chance

October 5, 2004

I have actually printed out the LMRP from the carrier, highlighted

pertinent areas and dropped by the doctor's office for a brief review.

They were impressed that I could provide a reference (vs. " those crazy

PT's and their Medicare rules " ) and happy to comply with any of my

future requests. " That , she knows what she is talking about when

it comes to Medicare... " :-)

Pennisi

Lakeshore Sports Physical Therapy

Chicago, IL

Certification - challenge = chance

There seems to be the constant issue of what to do with the medicare

patient when they really dont need therapy any longer, but the doctor

wants them to continue. Certification. Discharge. Ugh.

Forgive me for the insulting pointing out of the obvious. But has

anyone gone to the doctor, gotten 2 or 3 face to face minutes, and

explained the rules? Docs do not always know their role and

responsibility as it relates to various payors.

Far too often, in my observation, PTs are intimidated when speaking

to a potential referral source, and cannot tactfully find a way to

speak the obvious, which is this: " Sir/ Mam... what you have asked me

to do is illegal. "

Aside from Maill'y respeaking of the rules/ laws/ ethics/ etc, I

believe it paramount for PTs to try their best to teach docs what the

rules are. The wide spread failure of this is what causes doctors to

not know the medicare rules.

Far too often, have doc's said to me, " Just send me what I need to

sign. I'll sign it. " I try to respond with, " Well, that no longer

meets the standard set by the most recent medicare transmittal. "

Then, I hope for the best. Hope that other PTs are also playing by

the rules. Hope that other PTs will also honor the rules as they are

written. And hope that other PTs do not filter misinformation to the

docs, making them believe that signing something once a month is Okay.

I hope that others have something to offer on this important one.

- Simonetti, DPT

Chestertown, MD

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October 5, 2004

I feel this situation usually arises from inadequate communication to the MD

that their patient has little of no remaining functional deficits. A short,

concise, typed report with statements such as " residual minor functional

deficits should subside with continuation of current home exercise program,

of which patient is independent with " usually solves the problem.

I'm not saying the PT's in this quandry fail to do this but if a PT

scribbles a hand written progress report it in NEVER read by the MD and may

lead to this situation. Any other healthcare professional would never dream

of a hand written report but I know some PT's still do this which makes us

appear " sub-professional " .