I am often asked what items must be on a physician order for a patient referred to outpatient physical, occupational and/or speech therapy services. Can a physician or other qualified practitioner just write “Evaluate and Treat”? Must the physician or practitioner list a frequency and duration on the order? As you can imagine, the answer is not simple.
To determine what items must be on a physician/practitioner order for a patient referred to outpatient physical, occupational and/or speech therapy services, you must look at your state practice act, the contract you signed with the insurance carrier as well as the insurance carriers’ therapy policies. Do any of those 3 list what is required on a physician/practitioner order for outpatient therapy services? If yes, follow the requirements of the one that is most restrictive.
The majority of state practice acts do not list what must be documented on a physician/practitioner order. When I read the Aetna, Cigna and UnitedHealthcare online therapy policies,
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What does CMS require?
CMS does not require an order for outpatient therapy services. CMS requires a signed and dated plan of care by the physician and therapist.
Yes, but then you will have to find a doctor willing to sign the plan of care. We require an order at my clinic because this guarantees a doctor will sign the plan of care.
Perhaps it guarantees, but not necessarily. I have seen some physicians not sign the plan of care as they state the physician order should suffice.
An MD and NNP can write and order and sign the POC. Can a podiatrist, dentist and chiropractor also write and sign the POC?
Please read my FAQs on this topic. Scroll down to February 27, 2015.
Here is an article I published June 5, 2018: http://gawendaseminars.com/2018/current-news-posts/chiropractors-dentists-signing-medicare-plan-care/
In the InPatient setting, who can sign a PT order? If it is a verbal order, how long does the Ordering practitioner have to co-sign it?
You would need to check with your hospital policies regarding inpatient orders.
In pure hospital / acute care / unit based settings (not same day/extended recovery part B services), do physicians need to sign the POC prior to the patient d/c?
When we use a UB 04 for out pt. hospital based PT bill must we ABSOLULTELY use the medical diagnosis from Rx or we could use all our treatment diagnoses (up to 8 per CMS manual)? Please provide input.
You would need to check with your state therapy board as well as the insurance carrier if you want to know if the medical diagnosis must be on the claim form.
Is there an expiration date on orders for Outpatient PT services? We generally keep try to keep to within 30 days.
That could be dependent upon the specific insurance carrier and/or your state practice act.