Physician signature for Inpatient PT/OT evals

[Guest guest]

Hello group,

I was wondering what other hospital based rehab clinics are doing to obtain

a signature for inpatient PT/OT evaluations. Also do you write

clarification orders.

Currently we dictate our evals and medical records makes sure that the evals

are signed after the therapist proofreads the eval. The signature always is

obtained after the patient is discharged.

Thanks for any input.

Sincerely,

Chad , PT, DPT, OCS

St. Francis Rehab and Sports Medicine

ville, MO

Chad, Bethann, and Lorelei <><

822 South Walnut

ville, MO 64468

[Guest guest]

We flag them in the chart, if missed, Med Records catches them at DC chart

review.

We have had good luck with color coded " sign me " labels , coded to service ,

Ortho -red , Internal Med - Green ect.

Ron Barbato PT

Corporate Director, Rehabilitation Services

Ephraim McDowell Health

Voice:

Fax:

rbarbato@...

Physician signature for Inpatient PT/OT evals

Hello group,

I was wondering what other hospital based rehab clinics are doing to obtain

a signature for inpatient PT/OT evaluations. Also do you write

clarification orders.

Currently we dictate our evals and medical records makes sure that the evals

are signed after the therapist proofreads the eval. The signature always is

obtained after the patient is discharged.

Thanks for any input.

Sincerely,

Chad , PT, DPT, OCS

St. Francis Rehab and Sports Medicine

ville, MO

Chad, Bethann, and Lorelei <><

822 South Walnut

ville, MO 64468

Please identify yourself, your discipline and your location in all posts to

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[Guest guest]

We hand-write our eval [forms used are very user-friendly w/ lots of

fill-in -the-blank and check boxes]. The therapist signs; no physician

signature is obtained. Our department policy states: Evaluation and

documentation of the plan of care will be completed by the appropriate

therapist per hospital and department policy. If the physician

disagrees with the plan of care, he or she will clarify by written or

verbal order. If clarification orders are not received within 48 hours

this will indicate the physician agrees with the plan of care.

This process works well for us and has passed JCAHO without problem.

Irene Bartlett, Rehab Director

Mercy-Des Moines

Physician signature for Inpatient PT/OT evals

Hello group,

I was wondering what other hospital based rehab clinics are doing to

obtain a signature for inpatient PT/OT evaluations. Also do you write

clarification orders.

Currently we dictate our evals and medical records makes sure that the

evals are signed after the therapist proofreads the eval. The signature

always is obtained after the patient is discharged.

Thanks for any input.

Sincerely,

Chad , PT, DPT, OCS

St. Francis Rehab and Sports Medicine

ville, MO

Chad, Bethann, and Lorelei <><

822 South Walnut

ville, MO 64468

Please identify yourself, your discipline and your location in all posts

to PTManager

Looking to start and own 100% of your own Practice?

Visit www.InHomeRehab.com.

PTManager encourages participation in your professional association.

Join and participate now!

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[Guest guest]

JCAHO may be OK but what about Medicare?

Ron Barbato PT

Corporate Director, Rehabilitation Services

Ephraim McDowell Health

Voice:

Fax:

rbarbato@...

Physician signature for Inpatient PT/OT evals

Hello group,

I was wondering what other hospital based rehab clinics are doing to

obtain a signature for inpatient PT/OT evaluations. Also do you write

clarification orders.

Currently we dictate our evals and medical records makes sure that the

evals are signed after the therapist proofreads the eval. The signature

always is obtained after the patient is discharged.

Thanks for any input.

Sincerely,

Chad , PT, DPT, OCS

St. Francis Rehab and Sports Medicine

ville, MO

Chad, Bethann, and Lorelei <><

822 South Walnut

ville, MO 64468

Please identify yourself, your discipline and your location in all posts

to PTManager

Looking to start and own 100% of your own Practice?

Visit www.InHomeRehab.com.

PTManager encourages participation in your professional association.

Join and participate now!

Please identify yourself in all postings to PTManager.

[Guest guest]

This question referred to inpatients (unless I misread the question) --

my answer refers to how we handle referrals and documentation for our

acute hospital inpatient therapies. In the past, I discussed this

process with our compliance officer and our Director of Medical Records,

and our consensus was that we comply with the Medicare conditions of

participation.

Have you experienced a problem with a similar process?

Irene

Physician signature for Inpatient PT/OT evals

Hello group,

I was wondering what other hospital based rehab clinics are doing to

obtain a signature for inpatient PT/OT evaluations. Also do you write

clarification orders.

Currently we dictate our evals and medical records makes sure that the

evals are signed after the therapist proofreads the eval. The signature

always is obtained after the patient is discharged.

Thanks for any input.

Sincerely,

Chad , PT, DPT, OCS

St. Francis Rehab and Sports Medicine

ville, MO

Chad, Bethann, and Lorelei <><

822 South Walnut

ville, MO 64468

Please identify yourself, your discipline and your location in all posts

to PTManager

Looking to start and own 100% of your own Practice?

Visit www.InHomeRehab.com.

PTManager encourages participation in your professional association.

Join and participate now!

Please identify yourself in all postings to PTManager.

[Guest guest]

No,but we get them all signed.

I guess if your MD's are ordering a protocol or order set then in essence

they are specifying the POC.

We have always taken the position that since our orders are generic, (eval

and treat) that the POC developed by the PT/OT/ST must be signed by the MD

in accordance with Medicare guidelines. We are 70% medicare.

Per Medicare

A referral or order is not specifically required by Medicare. In the

Section 220.1.1 of the Manual, " the certification requirements are met when

the physician certifies the plan of care " However, it adds, " Payment is

dependent on the certification of the plan of care rather than the order,

but the use of an order is prudent to determine that a physician is involved

in care and available to certify the plan " Even though a referral is not

required, a signature by a physician/NPP is required for the plan of care.

If a Medicare patient who does not have a referral makes contact with a PT,

there should be a call to the physician so that there is not confusion when

trying to acquire the signature later. Also be aware that some states

require the referral or order as well.

Ron Barbato PT

Corporate Director, Rehabilitation Services

Ephraim McDowell Health

Voice:

Fax:

rbarbato@...

Physician signature for Inpatient PT/OT evals

Hello group,

I was wondering what other hospital based rehab clinics are doing to

obtain a signature for inpatient PT/OT evaluations. Also do you write

clarification orders.

Currently we dictate our evals and medical records makes sure that the

evals are signed after the therapist proofreads the eval. The signature

always is obtained after the patient is discharged.

Thanks for any input.

Sincerely,

Chad , PT, DPT, OCS

St. Francis Rehab and Sports Medicine

ville, MO

Chad, Bethann, and Lorelei <><

822 South Walnut

ville, MO 64468

Please identify yourself, your discipline and your location in all posts

to PTManager

Looking to start and own 100% of your own Practice?

Visit www.InHomeRehab.com.

PTManager encourages participation in your professional association.

Join and participate now!

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[Guest guest]

I believe this certification only refers to outpatient

care. In my 35 years of practice in acute care, we

have never had a physicians sign anything. Our evals

and notes are in the medical record. They can review

and contact the therapist if they have any questions.

Pat Cornwell

Palos Community Hospital

Palos Heights, Illinois

--- Ron Barbato wrote:

> No,but we get them all signed.

> I guess if your MD's are ordering a protocol or

> order set then in essence

> they are specifying the POC.

> We have always taken the position that since our

> orders are generic, (eval

> and treat) that the POC developed by the PT/OT/ST

> must be signed by the MD

> in accordance with Medicare guidelines. We are 70%

> medicare.

>

> Per Medicare

> A referral or order is not specifically required by

> Medicare. In the

> Section 220.1.1 of the Manual, " the certification

> requirements are met when

> the physician certifies the plan of care " However,

> it adds, " Payment is

> dependent on the certification of the plan of care

> rather than the order,

> but the use of an order is prudent to determine that

> a physician is involved

> in care and available to certify the plan " Even

> though a referral is not

> required, a signature by a physician/NPP is required

> for the plan of care.

> If a Medicare patient who does not have a referral

> makes contact with a PT,

> there should be a call to the physician so that

> there is not confusion when

> trying to acquire the signature later. Also be

> aware that some states

> require the referral or order as well.

>

> Ron Barbato PT

> Corporate Director, Rehabilitation Services

> Ephraim McDowell Health

> Voice:

> Fax:

> rbarbato@...

>

>

> Physician signature for

> Inpatient PT/OT evals

>

> Hello group,

>

> I was wondering what other hospital based rehab

> clinics are doing to

> obtain a signature for inpatient PT/OT evaluations.

> Also do you write

> clarification orders.

>

> Currently we dictate our evals and medical records

> makes sure that the

> evals are signed after the therapist proofreads the

> eval. The signature

> always is obtained after the patient is discharged.

>

> Thanks for any input.

>

> Sincerely,

> Chad , PT, DPT, OCS

> St. Francis Rehab and Sports Medicine

> ville, MO

>

>

> Chad, Bethann, and Lorelei <><

> 822 South Walnut

> ville, MO 64468

>

>

>

>

>

>

>

> Please identify yourself, your discipline and your

> location in all posts

> to PTManager

>

> Looking to start and own 100% of your own Practice?

>

> Visit www.InHomeRehab.com.

> PTManager encourages participation in your

> professional association.

> Join and participate now!

>

> Please identify yourself in all postings to

> PTManager.

>

[Guest guest]

Ok, I'm probably exposing my ignorance in this case (my lame defense being that

I manage the outpatient areas of our hospital, not acute care), or just

misunderstanding the thread here. We do not have physicians sign off on a plan

of care for acute care orders (or inpatient rehab orders for that matter). I

have never heard that the signing of the plan of care was to be applied to the

acute care setting, rather only the outpatient setting. Payment is not by fee

schedule for acute care, rather on a DRG. I would appreciate the references that

refer specifically that signing of the plan of care by a physician is required

in the acute care setting. Thanks.

Mike Hampton, PT

Outpatient Therapy Manager

St. ph Hospital

Physician signature for Inpatient PT/OT evals

Hello group,

I was wondering what other hospital based rehab clinics are doing to

obtain a signature for inpatient PT/OT evaluations. Also do you write

clarification orders.

Currently we dictate our evals and medical records makes sure that the

evals are signed after the therapist proofreads the eval. The signature

always is obtained after the patient is discharged.

Thanks for any input.

Sincerely,

Chad , PT, DPT, OCS

St. Francis Rehab and Sports Medicine

ville, MO

Chad, Bethann, and Lorelei <><

822 South Walnut

ville, MO 64468

Please identify yourself, your discipline and your location in all posts

to PTManager

Looking to start and own 100% of your own Practice?

Visit www.InHomeRehab.com.

PTManager encourages participation in your professional association.

Join and participate now!

Please identify yourself in all postings to PTManager.

[Guest guest]

Ron,

Section 220.1.1 of Chapter 15 of Pub 100-2 applies for

outpatient therapy and not acute care.

Rick Gawenda, PT

Director PM & R

Detroit Receiving Hospital

--- Ron Barbato wrote:

> No,but we get them all signed.

> I guess if your MD's are ordering a protocol or

> order set then in essence

> they are specifying the POC.

> We have always taken the position that since our

> orders are generic, (eval

> and treat) that the POC developed by the PT/OT/ST

> must be signed by the MD

> in accordance with Medicare guidelines. We are 70%

> medicare.

>

> Per Medicare

> A referral or order is not specifically required by

> Medicare. In the

> Section 220.1.1 of the Manual, " the certification

> requirements are met when

> the physician certifies the plan of care " However,

> it adds, " Payment is

> dependent on the certification of the plan of care

> rather than the order,

> but the use of an order is prudent to determine that

> a physician is involved

> in care and available to certify the plan " Even

> though a referral is not

> required, a signature by a physician/NPP is required

> for the plan of care.

> If a Medicare patient who does not have a referral

> makes contact with a PT,

> there should be a call to the physician so that

> there is not confusion when

> trying to acquire the signature later. Also be

> aware that some states

> require the referral or order as well.

>

> Ron Barbato PT

> Corporate Director, Rehabilitation Services

> Ephraim McDowell Health

> Voice:

> Fax:

> rbarbato@...

>

>

> Physician signature for

> Inpatient PT/OT evals

>

> Hello group,

>

> I was wondering what other hospital based rehab

> clinics are doing to

> obtain a signature for inpatient PT/OT evaluations.

> Also do you write

> clarification orders.

>

> Currently we dictate our evals and medical records

> makes sure that the

> evals are signed after the therapist proofreads the

> eval. The signature

> always is obtained after the patient is discharged.

>

> Thanks for any input.

>

> Sincerely,

> Chad , PT, DPT, OCS

> St. Francis Rehab and Sports Medicine

> ville, MO

>

>

> Chad, Bethann, and Lorelei <><

> 822 South Walnut

> ville, MO 64468

>

>

>

>

>

>

>

> Please identify yourself, your discipline and your

> location in all posts

> to PTManager

>

> Looking to start and own 100% of your own Practice?

>

> Visit www.InHomeRehab.com.

> PTManager encourages participation in your

> professional association.

> Join and participate now!

>

> Please identify yourself in all postings to

> PTManager.

>

[Guest guest]

What do you use for medicare certification? We combine the eval into the

certification so we only do 1 form? Then the physician signs that.

Thanks,

Carroll , PT

Soddy Daisy, TN

Physician signature for Inpatient PT/OT evals

>

> Hello group,

>

> I was wondering what other hospital based rehab clinics are doing to

> obtain a signature for inpatient PT/OT evaluations. Also do you write

> clarification orders.

>

> Currently we dictate our evals and medical records makes sure that the

> evals are signed after the therapist proofreads the eval. The signature

> always is obtained after the patient is discharged.

>

> Thanks for any input.

>

> Sincerely,

> Chad , PT, DPT, OCS

> St. Francis Rehab and Sports Medicine

> ville, MO

>

>

> Chad, Bethann, and Lorelei <><

> 822 South Walnut

> ville, MO 64468

>

>

>

>

>

>

>

> Please identify yourself, your discipline and your location in all posts

> to PTManager

>

> Looking to start and own 100% of your own Practice?

> Visit www.InHomeRehab.com.

> PTManager encourages participation in your professional association.

> Join and participate now!

>

> Please identify yourself in all postings to PTManager.

>

[Guest guest]

One thing I might caution folks about on the " Acute " side is the fact

that some patients seen in the hospital are not truly inpatients. Don't

forget that some procedures done at your facility may be done on an

outpatient basis. Also, some patients your therapists see/treat could

be designated as " Observation " . My understanding is that Observation

patients are paid like outpatients not inpatients.

I am a little less clear on the Obs patients and would appreciate any

feedback from those in the know. We resorted to a " back-end " process in

which staff in the Patient Accounts Department flag the Outpatient

procedure patients and Obs patients and we do ask for physician's

signature on those.

Trumbull

Director of Rehabilitation Services

BroMenn Regional Medical Center

Physician signature for Inpatient PT/OT evals

>

> Hello group,

>

> I was wondering what other hospital based rehab clinics are doing to

> obtain a signature for inpatient PT/OT evaluations.

> Also do you write

> clarification orders.

>

> Currently we dictate our evals and medical records makes sure that the

> evals are signed after the therapist proofreads the eval. The

> signature always is obtained after the patient is discharged.

>

> Thanks for any input.

>

> Sincerely,

> Chad , PT, DPT, OCS

> St. Francis Rehab and Sports Medicine

> ville, MO

>

>

> Chad, Bethann, and Lorelei <><

> 822 South Walnut

> ville, MO 64468

>

>

>

>

>

>

>

> Please identify yourself, your discipline and your location in all

> posts to PTManager

>

> Looking to start and own 100% of your own Practice?

>

> Visit www.InHomeRehab.com.

> PTManager encourages participation in your professional association.

> Join and participate now!

>

> Please identify yourself in all postings to PTManager.

>

[Guest guest]

We also have the Transitional care patients, rehab bed patients, as well as

OP observation patients, it is just easier for us to get them all signed.

That way we don't miss any. Easy for us to do, and Med staff is well

trained and willing.

Ron Barbato PT

Corporate Director, Rehabilitation Services

Ephraim McDowell Health

Voice:

Fax:

rbarbato@...

Physician signature for Inpatient PT/OT evals

>

> Hello group,

>

> I was wondering what other hospital based rehab clinics are doing to

> obtain a signature for inpatient PT/OT evaluations.

> Also do you write

> clarification orders.

>

> Currently we dictate our evals and medical records makes sure that the

> evals are signed after the therapist proofreads the eval. The

> signature always is obtained after the patient is discharged.

>

> Thanks for any input.

>

> Sincerely,

> Chad , PT, DPT, OCS

> St. Francis Rehab and Sports Medicine

> ville, MO

>

>

> Chad, Bethann, and Lorelei <><

> 822 South Walnut

> ville, MO 64468

>

>

>

>

>

>

>

> Please identify yourself, your discipline and your location in all

> posts to PTManager

>

> Looking to start and own 100% of your own Practice?

>

> Visit www.InHomeRehab.com.

> PTManager encourages participation in your professional association.

> Join and participate now!

>

> Please identify yourself in all postings to PTManager.

>

[Guest guest]

Rick,

Does this also apply to Observation patients?

Jill Piazza, PT, MSPT

Florida Hospital Deland

Physician signature for

>> Inpatient PT/OT evals

>>

>> Hello group,

>>

>> I was wondering what other hospital based rehab

>> clinics are doing to

>> obtain a signature for inpatient PT/OT evaluations.

>> Also do you write

>> clarification orders.

>>

>> Currently we dictate our evals and medical records

>> makes sure that the

>> evals are signed after the therapist proofreads the

>> eval. The signature

>> always is obtained after the patient is discharged.

>>

>> Thanks for any input.

>>

>> Sincerely,

>> Chad , PT, DPT, OCS

>> St. Francis Rehab and Sports Medicine

>> ville, MO

>>

>>

>> Chad, Bethann, and Lorelei <><

>> 822 South Walnut

>> ville, MO 64468

>>

>>

>>

>>

>>

>>

>>

>> Please identify yourself, your discipline and your

>> location in all posts

>> to PTManager

>>

>> Looking to start and own 100% of your own Practice?

>>

>> Visit www.InHomeRehab.com.

>> PTManager encourages participation in your

>> professional association.

>> Join and participate now!

>>

>> Please identify yourself in all postings to

>> PTManager.

>>

[Guest guest]

Or are hospitalized observation pts different than standard out pts

because the MD is checking them and the chart(where the PT eval is present

for review) daily?

Pierre H. Rougny, PT MTC

Director of Rehab

Sebasticook Valley Hospital

21 Leighton St.

Pittsfield, ME 04967

(207)487-9293 Re: Physician signature for Inpatient PT/OT evals

Rick,

Does this also apply to Observation patients?

Jill Piazza, PT, MSPT

Florida Hospital Deland

Physician signature for

>> Inpatient PT/OT evals

>>

>> Hello group,

>>

>> I was wondering what other hospital based rehab

>> clinics are doing to

>> obtain a signature for inpatient PT/OT evaluations.

>> Also do you write

>> clarification orders.

>>

>> Currently we dictate our evals and medical records

>> makes sure that the

>> evals are signed after the therapist proofreads the

>> eval. The signature

>> always is obtained after the patient is discharged.

>>

>> Thanks for any input.

>>

>> Sincerely,

>> Chad , PT, DPT, OCS

>> St. Francis Rehab and Sports Medicine

>> ville, MO

>>

>>

>> Chad, Bethann, and Lorelei <><

>> 822 South Walnut

>> ville, MO 64468

>>

>>

>>

>>

>>

>>

>>

>> Please identify yourself, your discipline and your

>> location in all posts

>> to PTManager

>>

>> Looking to start and own 100% of your own Practice?

>>

>> Visit www.InHomeRehab.com.

>> PTManager encourages participation in your

>> professional association.

>> Join and participate now!

>>

>> Please identify yourself in all postings to

>> PTManager.

>>