Hi Suzanne et al: I consult for some nursing homes. Hopefully, this info. will be helpful. Jimmie was right that this was basically a cover-up procedure . Since our signed 'plan of treatment' (POT) does not return by the doctor on time. The t.o clarification stands in lieu.
Suzanne- the 30 day certification is appropriate for outpatient therapies/ those under Part B. The regs state that the physician must certify/ recertify need for skilled services per the POT developed by him or in conjunction to the therapist, and that the patient is under his/her care; and that the patient was 'seen' at least once every 30 days. The POT is established post evaluation or shortly thereafter (it is okay to take 2-3 visits to establish a complete POT). The certification period in CORFs is 60 days. If your telephone order initially said 5x/ wk for 12 weeks (if that what you think is necessary and reasonable), that is fine. But you need a written proof of some sort that the patient was seen by a physician and recertified 30 days since SOC (start of care) or last certification. This could even be accomplished by a seperate script. Again, remember you must do an updated POT (most places use HCFA, now CMS 701) every 30 days, and this is usually where the physician certifies. For consistency and eaze, we recommend all telephone orders and plan of treatment to match. For part As the certification requirements are different- The physician certifies need for skilled services under Part A at the time of admission or, per deferred requirements. If skilled care undeferred, the patient is already under a skilled plan of care. The physician needs to sign the interim plan of care including nursing skills/ PT/ OT/ST per the following schedule- 1. 3 days post admission (72 hours) 2. 14 days post admission 3. 30 days, thereafter. The clarification orders in SNFs usually serve the following purposes- 1. Communicating to the nurses/ MDS reasons for therapies skilling which goes on the physician certification/ recertification form 2. Usually the pharmacy serving the SNF or via a centralized mechanism, SNFs track all physician orders. It will be difficult to do so with 700s and 701s. 3. Redundancy- just incase physician forgets to sign your 700 or 701, or you forget to send it to them on time 4. Time saver- continue therapies instead of waiting till the physician signs the plan/ updated plan of treatment (700/701). Again, with part A if the patient was admitted to the facility with orders for OT to treat, the plan of treatment/ telephone orders is basically a coutesy; because you have other certification requirements that also spell out why OT is skilling the patient. With part As, it is not necessary to do a recertification form (701) every 30 days. Joe ----- Original Message ----- From: "Suzanne Martin" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Wednesday, July 09, 2003 9:06 PM Subject: Re: [OTlist] "clarifying orders" for SNF rehab > I have been working in Maine since 1998 and we always had to do > clarification orders. Everthing you do has to be in the clarification order. > Think of "ADL retraining", or whatever, as the same as any treatment or > medication, if the doctor has not approved it, you can't do it, and > insurance companies or Medicare don't have to pay for it. I have seen > problems with home safety evals and modalities. If someone gets hurt with a > modality, or on a home visit you didn't have an order for, you are in big > trouble, not to mention loosing big bucks if they are not covered just > because somebody forgot to add that to the order. Also remember that you > need to recert the orders at least every 30 days. If your order is only for > two weeks and you go over without the recert you won't get paid. An order > for over 30 days is still only good for 30 days. It sounds like a big pain, > but the doctor needs to know what exactly the patient is receiving, from all > departments, and the way that is documented is through him or her signing > the plan of care, or clarification orders. Hope this helps. > Suzanne > > > >From: "Hidu, Debbie" <[EMAIL PROTECTED]> > >Reply-To: [EMAIL PROTECTED] > >To: "'[EMAIL PROTECTED]'" <[EMAIL PROTECTED]> > >Subject: [OTlist] "clarifying orders" for SNF rehab > >Date: Wed, 9 Jul 2003 11:51:45 -0400 > > > > > >Ok so a patient is admitted to the SNF unit with orders for PT and OT 5-7 > >days a week. > >The evaluation is done and the therapist now has to call the MD and > >"clarify" that OT (or PT) will be seeing the patient 5-7x/wk for the > >following problems using the following approaches. > >then a "clarifying order" has to go in the chart stating this and be signed > >by the doctor (resulting in two therapy orders now in the chart). This is > >a > >new practice where I work (US state of Maine)and I was wondering if anyone > >knows the origin/purpose/whether this is reall necessary....etc. can > >anyone > >shed any light on this? > > > > > >*****************************®©********************************** > > > >To remove yourself from the OTnow mail list, send a message to: > > > >[EMAIL PROTECTED] > > > >In the message's *body*, put the following text: > > > >unsubscribe OTlist > > > >- > > > >List messages are archived at: > > > >http://www.mail-archive.com/[EMAIL PROTECTED] > > > >*****************************®©*********************************** > > > > _________________________________________________________________ > The new MSN 8: advanced junk mail protection and 2 months FREE* > http://join.msn.com/?page=features/junkmail > > > *****************************®©********************************** > > To remove yourself from the OTnow mail list, send a message to: > > [EMAIL PROTECTED] > > In the message's *body*, put the following text: > > unsubscribe OTlist > > - > > List messages are archived at: > > http://www.mail-archive.com/[EMAIL PROTECTED] > > *****************************®©*********************************** > *****************************®©********************************** To remove yourself from the OTnow mail list, send a message to: [EMAIL PROTECTED] In the message's *body*, put the following text: unsubscribe OTlist - List messages are archived at: http://www.mail-archive.com/[EMAIL PROTECTED] *****************************®©***********************************
