NOMNC forms

[Guest guest]

Hi all-

I am began working in a new outpatient corporate owned multi disciplined

practice. For Medicare, and Medicare HMOs we are asking the patient to

sign this form Notice of Medicare Provider Non coverage (CMS form no.

10123). This specifically states when their doctor's " prescription " to

come to therapy will expire. I have never seen anything like this

before in my past 12 years of experience. This company makes the PT

discuss this with the patient at the time of their evaluation. If the

patient's " prescription " time is extended either by a new script, or a

re-certification, it is the therapists' responsibility to have the

patient sign that form again. Does anyone else use this form, and if

so, is it the therapists' responsibility or the front desk's

responsibility?

Thanks

Rich etti, MSPT

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[Guest guest]

Hi all. Re- sending this, as I have not had a response. Does anyone

use this form? It seems redundant to me.

________________________________

From: etti,

Sent: Friday, August 08, 2008 3:42 PM

To: 'PTManager '

Subject: NOMNC forms

Hi all-

I am began working in a new outpatient corporate owned multi disciplined

practice. For Medicare, and Medicare HMOs we are asking the patient to

sign this form Notice of Medicare Provider Non coverage (CMS form no.

10123). This specifically states when their doctor's " prescription " to

come to therapy will expire. I have never seen anything like this

before in my past 12 years of experience. This company makes the PT

discuss this with the patient at the time of their evaluation. If the

patient's " prescription " time is extended either by a new script, or a

re-certification, it is the therapists' responsibility to have the

patient sign that form again. Does anyone else use this form, and if

so, is it the therapists' responsibility or the front desk's

responsibility?

Thanks

Rich etti, MSPT

This communication may contain confidential Protected Health Information. This

information is intended only for the use of the individual or entity to which it

is addressed. The authorized recipient of this information is prohibited from

disclosing this information to any other party unless required to do so by law

or regulation and is required to destroy the information after its stated need

has been fulfilled.

If you are not the intended recipient, you are hereby notified that any

disclosure, copying, distribution, or action taken in reliance on the contents

of these documents is strictly prohibited by federal law. If you have received

this information in error, please notify the sender immediately and arrange for

the return or destruction of these documents.

______________________________________________________________________

This email has been scanned by VCPI Managed Email Content Services, powered by

MessageLabs technology.

[Guest guest]

Thanks all.

We are a CORF, so I guess this form does apply. I just do not

understand why, and the answers I get are something like, well that's

the way it is. We do not use an ABN form in this instance because we do

not hold the pt fiscally responsible if they go " past their script

time " . We would/could not do that. Basically, the therapist reviews

the POC with the pt and tells the pt ...your doctor has prescribed

therapy until X, and I need you to sign this form stating that you are

aware. Should we need further care beyond that date, the PT will

contact the physician to extend PT, and there will be a new form to

sign.

I have always reviewed this with pts as good business/ customer service

practice over the years. So, why now that I work for a CORF is this form

necessary?

Rich

________________________________

From: PTManager [mailto:PTManager ] On

Behalf Of mlavcavitt@...

Sent: Thursday, August 14, 2008 8:31 AM

To: PTManager

Subject: Re: FW: NOMNC forms

Rich,

My understanding is this form is required for SNFs, HHAs and CORFs. Go

to

_www.cms.gov_ (http://www.cms.gov <http://www.cms.gov> ) and in the

search engine type " CMS Form

10123. " There you will find both the form and the instructions for the

use of

the form.

Hope this helps. If you find out something different, please share!

Vickie

D. Cavitt, President

Medical Legal Alliance, L.L.C.

In a message dated 8/14/2008 7:14:58 A.M. Central Daylight Time,

Retti@... <mailto:Retti%40extendicare.com>

writes:

Hi all. Re- sending this, as I have not had a response. Does anyone

use this form? It seems redundant to me.

________________________________

From: etti,

Sent: Friday, August 08, 2008 3:42 PM

To: _'PTManager@yahoogro'PTMana_ (mailto:'PTManager

<mailto:%27PTManager%40yahoogroups.com> ) '

Subject: NOMNC forms

Hi all-

I am began working in a new outpatient corporate owned multi disciplined

practice. For Medicare, and Medicare HMOs we are asking the patient to

sign this form Notice of Medicare Provider Non coverage (CMS form no.

10123). This specifically states when their doctor's " prescription " to

come to therapy will expire. I have never seen anything like this

before in my past 12 years of experience. This company makes the PT

discuss this with the patient at the time of their evaluation. If the

patient's " prescription " time is extended either by a new script, or a

re-certification, it is the therapists' responsibility to have the

patient sign that form again. Does anyone else use this form, and if

so, is it the therapists' responsibility or the front desk's

responsibility?

Thanks

Rich etti, MSPT

This communication may contain confidential Protected Health

Information.

This information is intended only for the use of the individual or

entity to

which it is addressed. The authorized recipient of this information is

prohibited from disclosing this information to any other party unless

required to do

so by law or regulation and is required to destroy the information after

its

stated need has been fulfilled.

If you are not the intended recipient, you are hereby notified that any

disclosure, copying, distribution, or action taken in reliance on the

contents of

these documents is strictly prohibited by federal law. If you have

received

this information in error, please notify the sender immediately and

arrange

for the return or destruction of these documents.

__________________________________________________________

This email has been scanned by VCPI Managed Email Content Services,

powered

by MessageLabs technology.