Date of Referral

[Guest guest]

We have had a standard at our facility of requiring an updated referral if a

patient comes in for an initial evaluation with a referral that is over 30 days

old.

I am just doing a double check as to why we are doing this. The assumption has

been that there is a legal or reimbursement issue that requires this. I have

reviewed our State Practice Act and there is no mention of the need to have an

evaluation within a certain time frame of when a referral is written (in fact,

we are a direct access State). My facility has no policy that specifies this

either.

In regards to Medicare, since a referral is technically not needed and we are

OK with the signed plan of care, it seems to not be an issue with this specific

payer.

I have not taken the time to check every payer we deal with (which would take

a lot of time), but maybe there are certain payers that require such a time

frame?

If there is really no such requirement, it would really help us with those

patients that come in with referrals over 30 days old as we would stop hounding

physician's offices for an updated referral.

Of course, the assumption in these cases would be that the therapist is using

their professional judgment in determining if the referral is still appropriate

etc.

Thanks for any input and thoughts on the subject.

Mike Hampton, PT

Outpatient Therapy Manager

St. ph Hospital

Bellingham, WA

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