<<QUOTE
The Medicare policy regarding the requirement for the
physician signature on the therapy plan
of treatment has not changed. As is
stated in the SNF Manual, rehabilitation
therapy services provided to a
beneficiary in a SNF must be directly
and specifically related to an active
written treatment plan established by
the physician after any needed
consultation with a qualified therapist.
Implementation of the PPS did nothing
to alter this guideline. We will,
however, take this opportunity to clarify
what is required for coverage of
rehabilitation therapy.
As stated in the language in the SNF
Manual cited in the preceding
paragraph, Medicare requires the
physician to make decisions regarding
the amount and intensity of
rehabilitation therapy services provided
to Medicare beneficiaries in SNFs after
consulting with the professional
We expect that the same care will be
taken by the physician and SNF staff to
document physician responsibility for
developing the therapy plan of
treatment, including precautions, that is
reasonably expected to be taken for any
other element of the medical record. We
realize, however, that in the SNF setting
there may not be a physician on the
premises every day. Therefore, Medicare
allows the professional therapist to
develop a suggested plan of treatment
and to begin providing services based
on that plan prior to obtaining the
physician's signature on the plan. We
continue to require that the plan of
treatment must be a physician's
responsibility after any needed
consultation with a qualified therapist,
and that the requirement for physician
verification of the suggested plan of
treatment will be obtained within a
reasonable amount of time. However, a
physician signature must be obtained
before the facility bills Medicare for
payment for the rehabilitation therapy
services provided to the beneficiary
based on the plan of treatment he or she
has approved. In this way, the facility
can be sure that the level of therapy for
which it bills Medicare is the level the
physician deems to be medically
necessary. We expect that the type and
intensity of therapy billed will always
match the type and intensity of therapy
on the signed therapy plan of treatment.
>>END QUOTE
In this process, the telephone order constitutes the treatment plan that the physician must sign (as long as the orders contain the required components). The treatment plan ordered by the physician constitutes a change in the resident's treatment and would be coded on the MDS as a day with an order change.
Rena
Rena R. Shephard, MHA, RN, FACDONA, RAC-C
Chair, American Association of Nurse Assessment Coordinators
[EMAIL PROTECTED]
Subj: RE: Doctors orders
Date: 2/17/04 4:02:05 PM Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the Internet
No I would call the Dr and ask for a clarification and THAT I couldn't
count.
I understand the reasoning behind PPS and the rehab mins. But as you said
most Drs will not give exact orders unless therapy has evaled them and you
need an order for that.
-----Original Message-----
From: Nathan [mailto:[EMAIL PROTECTED]
Sent: Tuesday, February 17, 2004 5:43 PM
To: [EMAIL PROTECTED]
Subject: Re: Doctors orders
Where in that order does it give any indication how much treatment to
deliver? If the Dr. wrote "Give some antibiotics", would you?
PPS pays based on the amount of therapy ordered and delivered in minutes and
day. If they paid on therapy "Yes" or "No" then the Eval and Treat order
might be ok, but they don't.
----- Original Message -----
From: "Richardson, Christine" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Tuesday, February 17, 2004 1:49 PM
Subject: RE: Doctors orders
>When a res is admitted with orders on admission its my understanding these
>can not be counted unless there is a change in the original orders during
>that day. Most of my admissions come with evale and treat orders for
>therapies. The following orders are clarifying the admission order.
>01/01/04 Admitted with ST/PT/OT orders for evale and treat( why is this
not
>a complete order?)
>01/02/2004 received clarification from Dr for TX
>
>
>
>-----Original Message-----
>From: Nathan [mailto:[EMAIL PROTECTED]
>Sent: Tuesday, February 17, 2004 3:35 PM
>To: [EMAIL PROTECTED]
>Subject: Re: Doctors orders
>
>
>The term "Standard Admission Orders" does not mean the orders written when
a
>resident is admitted. This refers to standing orders that are applied to
all
>admssions for a certain MD. As for not being able to use admitting orders
to
>count for therapy...I have never heard. There is a problem when the MD
>writes "Eval and Treat". That is not a complete order. The MD must as some
>point indicate the days and minutes of therapy to be delivered. Therapy
must
>be doctor ordered, not therapist ordered. If the MD is not willing to
write
>actual minutes and day without an eval (most won't and I don't blame them)
>This becomes a three part process to do correctly.
>
>One - MD writes an order for "Evaluation and recommendation" for the
>therapist.
>Two - The therapist does the eval and recommneds X days and X minutes per
>day.
>Three - The MD then writes a second order for X days and X minutes per day
>of therapy. I would guess that part three could be fulfilled by an order
>from the MD to "Eval and Treat as recommended" as long as the third part
was
>dated/timed after the second part. In effect, the recommendation of the
>therapist would become part of the MD order.
>
>
>Nathan
>
>
>----- Original Message -----
>From: "Richardson, Christine" <[EMAIL PROTECTED]>
>To: <[EMAIL PROTECTED]>
>Sent: Tuesday, February 17, 2004 1:02 PM
>Subject: RE: Doctors orders
>
>
>>Section P page 3-205 in RAI under physician orders states
>> Does note include standard admission orders, return admission orders,
>>renewal orders or clarifying orders with out changes.
>>
>>-----Original Message-----
>>From: Jennifer [mailto:[EMAIL PROTECTED]
>>Sent: Tuesday, February 17, 2004 1:39 PM
>>To: [EMAIL PROTECTED]
>>Subject: RE: Doctors orders
>>
>>
>>Where does it state we can't count therapy orders? I
>>read through the whole section?
>>
>>Jennifer RN BSN MDS Coordinator
>>
>>--- "Richardson, Christine"
>><[EMAIL PROTECTED]> wrote:
>>>Cant count clarification orders, or therapy
>>>orders.Read section P in RAI
>>>manual
>>>
>>>-----Original Message-----
>>>From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]
>>>Sent: Monday, February 16, 2004 4:47 PM
>>>To: [EMAIL PROTECTED]
>>>Subject: Doctors orders
>>>
>>>
>>>If a resident is admitted with orders for Speech,
>>>Occupational and Physical
>>>therapies that state treat and eval as indicated,
>>>can you count orders the
>>>next day when they come in and the order is writtent
>>>to clarify specifically
>>>what they are going to do for example: speech
>>>therapy to treat 5x week x
>>>6weeks for .......
>>>
>>>Thanks,
>>>Carol
>>>
>>>
