Rx signature : Responses
Skewes, Ed
Description
Collection
Title:
Rx signature : Responses
Creator:
Skewes, Ed
Date:
7/25/2013
Text:
Question posted :
Is it legal for a Physician or PA (physician Assistant) to sign an Rx for a prosthetic device, or an orthotic device, without seeing or evaluating the patient for that device?
Edward Skewes CPO
Responses: and they vary :)...... Yes, No, and I don't know {:-0
I believe that it is not legal, and one of the Medicare webinars addresses this issue and said that the claim would be kicked out for review if the ordering physician had not billed for services within a certain time frame.
Brian Creighton BOCPO CTPO
Yes it is legal, but Medicare now requires a face-to-face with the referring physician.
Sent from Yahoo! Mail on Android
Hi Ed,
It looks like more and more insurance companies are wanting the physician notes from the same day they wrote the Rx. In terms of legality, SC is not a license state so you could see the patient without a Rx if they were paying for it themselves. Of course if you are an ABC Certified facility, then there may be some problems doing it that way.
Alex
Alexander L. Lyons, CPO, President Lyons P&O Lyons Prosthetics & Orthotics, Inc.
123 Waccamaw Medical Park Drive
Conway, SC 29526
843-347-5800
To my knowledge there is not a face-to-face requirements for prosthetics YET
Only for DME
Rob Huddler PT DPT CP
Advantage Prosthetics
Legal? Yes. Will it be enough for medicare? No. For private insurance you should be fine, at least for now.
For medicare (and I'm sure private insurance will follow soon), the patient needs to be seen for problems with the prosthesis, they much document the problems, and then bill for that appointment. We recently had a denial on a knee brace because the physician did not bill for visit concerning knee pain. Otto Bock, Ossur and Medicare all have templates that list all of the information that much be in the physician notes in order for a prosthesis to be billed for.
Hi Ed,
When it comes to physicians and CMS, it seems they are able to do what they want without penalty. If they F U a total knee arthroplasty They just say Well, the patient didn't respond well to the surgery and they just operate again and are payed again. No problem.
So, I guess they can issue an rx without seeing the patient but if the audit monsters come around, your paying some money back, again with no penalty to the Doc. Nice system!Be well,Mick Holm, CPO, LPO
your issue comes when there is no documentation from the physician regarding the ambulatory status, co-morbidities, at the time if the initial veal and treat script.
we don't allow this in our office. we require all patients to see their physician- and send packets with them regarding the LCD requirements, the physician letter, and a helpful documentation rack card that list the K levels
Kim
Not sure of the answer to that - I know of situations when it has happened at a clinic with which I was associated (and as such I would request you not share with the list). The Dr. is certainly taking a chance I would think. Could you add to the question if it's OK for the Dr. to see the client via Skype to sign? BTW, this is a Canadian observation!
Brad van Lenthe C.P.(c )
Not if it's Medicare.
Warren R Mays, CPO
In my opinion.
I believe the question should be whether it is legal to bill Medicare for the item.
A doctor can write a Rx having seen the pt in the past year, as is done all the time. The question is does Medicare have regulations that require a face-to-face meeting when paying for a prosthetic or orthotic item based upon a Rx from the same physician.
Example: A surgeon does a surgery. Sees pt for removal of stitches and writes Rx for preparatory prosthesis. 7 months later, O&P provider sends Rx to surgeon over fax for definitive. Surgeon signs and faxes back. Item billed to Medicare. Medicare may/may not want to audit this file due to doctor visit. O&P provider on hook, not MD.
No it is not legal. A prosthetic will not be covered without an evaluation from the physician. Shoes also need a written order from the treating Dr. Braces are usually not a problem because they are most times post op or post trauma so there is documentation usually on file to support medical necessity. Commercial carriers may vary but the best bet is to follow Medicare guidelines across the board.
I believe it is legal for you to fabricate without any prescription at all. You just will not get paid
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Is it legal for a Physician or PA (physician Assistant) to sign an Rx for a prosthetic device, or an orthotic device, without seeing or evaluating the patient for that device?
Edward Skewes CPO
Responses: and they vary :)...... Yes, No, and I don't know {:-0
I believe that it is not legal, and one of the Medicare webinars addresses this issue and said that the claim would be kicked out for review if the ordering physician had not billed for services within a certain time frame.
Brian Creighton BOCPO CTPO
Yes it is legal, but Medicare now requires a face-to-face with the referring physician.
Sent from Yahoo! Mail on Android
Hi Ed,
It looks like more and more insurance companies are wanting the physician notes from the same day they wrote the Rx. In terms of legality, SC is not a license state so you could see the patient without a Rx if they were paying for it themselves. Of course if you are an ABC Certified facility, then there may be some problems doing it that way.
Alex
Alexander L. Lyons, CPO, President Lyons P&O Lyons Prosthetics & Orthotics, Inc.
123 Waccamaw Medical Park Drive
Conway, SC 29526
843-347-5800
To my knowledge there is not a face-to-face requirements for prosthetics YET
Only for DME
Rob Huddler PT DPT CP
Advantage Prosthetics
Legal? Yes. Will it be enough for medicare? No. For private insurance you should be fine, at least for now.
For medicare (and I'm sure private insurance will follow soon), the patient needs to be seen for problems with the prosthesis, they much document the problems, and then bill for that appointment. We recently had a denial on a knee brace because the physician did not bill for visit concerning knee pain. Otto Bock, Ossur and Medicare all have templates that list all of the information that much be in the physician notes in order for a prosthesis to be billed for.
Hi Ed,
When it comes to physicians and CMS, it seems they are able to do what they want without penalty. If they F U a total knee arthroplasty They just say Well, the patient didn't respond well to the surgery and they just operate again and are payed again. No problem.
So, I guess they can issue an rx without seeing the patient but if the audit monsters come around, your paying some money back, again with no penalty to the Doc. Nice system!Be well,Mick Holm, CPO, LPO
your issue comes when there is no documentation from the physician regarding the ambulatory status, co-morbidities, at the time if the initial veal and treat script.
we don't allow this in our office. we require all patients to see their physician- and send packets with them regarding the LCD requirements, the physician letter, and a helpful documentation rack card that list the K levels
Kim
Not sure of the answer to that - I know of situations when it has happened at a clinic with which I was associated (and as such I would request you not share with the list). The Dr. is certainly taking a chance I would think. Could you add to the question if it's OK for the Dr. to see the client via Skype to sign? BTW, this is a Canadian observation!
Brad van Lenthe C.P.(c )
Not if it's Medicare.
Warren R Mays, CPO
In my opinion.
I believe the question should be whether it is legal to bill Medicare for the item.
A doctor can write a Rx having seen the pt in the past year, as is done all the time. The question is does Medicare have regulations that require a face-to-face meeting when paying for a prosthetic or orthotic item based upon a Rx from the same physician.
Example: A surgeon does a surgery. Sees pt for removal of stitches and writes Rx for preparatory prosthesis. 7 months later, O&P provider sends Rx to surgeon over fax for definitive. Surgeon signs and faxes back. Item billed to Medicare. Medicare may/may not want to audit this file due to doctor visit. O&P provider on hook, not MD.
No it is not legal. A prosthetic will not be covered without an evaluation from the physician. Shoes also need a written order from the treating Dr. Braces are usually not a problem because they are most times post op or post trauma so there is documentation usually on file to support medical necessity. Commercial carriers may vary but the best bet is to follow Medicare guidelines across the board.
I believe it is legal for you to fabricate without any prescription at all. You just will not get paid
CONFIDENTIALITY NOTICE: This e-mail communication and any attachments may contain confidential and privileged information for the use of the designated recipients. If you are not the intended recipient, (or authorized to receive for the recipient) you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its contents is prohibited. If you have received this communication in error, please destroy all copies of this communication and any attachments and contact the sender by reply e-mail or telephone (813) 281-0300.
Citation
Skewes, Ed, “Rx signature : Responses,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 26, 2024, https://library.drfop.org/items/show/235423.
