Chuck,
The DME can't use one of their own therapists, even if they have them.
Medicare requires an independent therapist do the evaluation, and it is an
evaluation. I run this through my Medicare OT practice, unless I can run it
through home health. I don't do a one time evaluation though. I also do
training once the w/c arrives and ride herd on the DME to get things done,
tweaks made (the DME has 3 months to tweak without additional cost).
Frequently if there is a need for a w/c there is also a need for OT in the
home.
When I do this through Medicare I have to have an order because of Medicare
regs. When through home health I have to have an order to see the person
because of home health regs.
Very rarely the person doesn't have Medicare and their insurance won't pay
for independent OT so then I bill the pt. directly, still with orders
though, just in case the insurance will pay, and I'm conservative and, my
evaluation is also the w/c recommendation that the MD must sign so I think
it prudent to let the MD know what I'm doing before I send a report that
will need the MD's signature.
Hope this helps. Laura W.
----- Original Message -----
From: "Charles Willmarth" <[EMAIL PROTECTED]>
To: <[email protected]>
Sent: Tuesday, July 19, 2005 2:42 PM
Subject: Re: [OTlist] Stand-alone Wheelchair Evals
Ron,
I spoke with Tara Alexandar in our reimbursement department about your
question:
My answer to this would be that if the therapist resides in a state
where they have direct access, then the therapist can conduct an
evaluation and provide a written report to the person without
jeopardizing their licensure or certification status. If they reside
in
a state that requires them to obtain a referral or script before any
services are rendered, then they should not be performing an
evaluation
for DME or any service without following proper protocols. I won't
even
get into to the distinction between an assessment and an evaluation.
An
assessment being a shorter and informal type of evaluation (ex. quick
checks performed at a mall or somewhere, no professional report
necessarily needed). My questions is why would a DME supplier be
asking
for a therapist to perform an evaluation for a wheelchair instead of
the
provider?
[EMAIL PROTECTED] 7/19/2005 12:21:25 PM >>>
Does anyone receive requests from DME's to perform power w/c evals on
a
patients that are not currently receiving therapy? How do you
handle
these situations?. For example, do you call the doctor's office
and
request a script prior to doing the eval? Do you do the eval without
a
script and just send the patient's doctor a copy of the eval?
To me, this seems to be a gray area. Medicare has all but mandated
a
therapy evaluation for power wheelchairs, but I can not find
any
documentation clearly delineating the procedural aspects of a
one-time
therapy evaluation for a power wheelchair.
Thanks,
Ron C.
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