There is a local orthopedist who owns 7-8 PT practices in my area. When we perform an Initial Evaluation on one of his Medicare patients, he refuses to sign off on our plan of care (POC) even though we have his prescription. We will follow up multiple times with his front desk staff and even have the patients contact the referring MD office. The response is that these Medicare patients must be seen at his clinic/PT office. Is that correct?
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We often have the issue of primary care providers refusing to sign a POC because the patient hadn’t been in to see them prior to starting PT. As Medicare is direct access is this a valid reason not to sign the POC?
Medicare is not direct access. The Medicare program does require a physician or NPP certify a therapy plan of care in order for you to receive payment. The physician does have the right to have the patient come in for an office visit in order to sign the therapy plan of care.
We had the same issue with a local family practice physician. He felt that was a ridiculous requirement so he simply refused to sign off on the paperwork. I finally had to tell him that without a signed plan of care we could not receive payment for services rendered; and as a businessman himself I was sure he understood that fact given he owned his own practice. Unless we could meet Medicare’s requirement for reimbursement we would no longer be able to treat his patients with Medicare billing status. If he was comfortable with them knowing they were responsible for private payment because we were unable to obtain the proper paperwork from their doctor then we would proceed without his signing the POC. I never had a problem getting him sign POC’s after that but he held them as long as he could before he sent them back.
If we send the POC to the MD multiple times requesting his/her signature and we can show that we’ve made these attempts, but still do not have the signature, is this acceptable by Medicare?
No! Upon an audit, the Medicare program does require the plan of care be signed and dated by the physician or NPP overseeing the care the Medicare beneficiary is receiving.
To be clear; if a PT Clinic has sent the POC to a physician and this physician has stated in both writing and verbally they accept no responsibility for this patient and will not sign the POC what in good faith are the options? Medicare aside; should the clinic continue to see the patient while they attempt to work it out with another physician (i.e. direct the patient to see their PCP or in this case establish a relationship with another PCP)? Thank you
That would be a decision for your management team to make.
In a hospital outpatient PT setting, is it a requirement to have a physician sign an established plan of care for a non-Medicare patient?
That would be payer specific. Majority of insurance carriers do not require a signed and dated POC, but they may require a physician order for outpatient therapy.