LISTSERV mailing list manager LISTSERV 16.5

Help for UVMFLOWNET Archives


UVMFLOWNET Archives

UVMFLOWNET Archives


UVMFLOWNET@LIST.UVM.EDU


View:

Message:

[

First

|

Previous

|

Next

|

Last

]

By Topic:

[

First

|

Previous

|

Next

|

Last

]

By Author:

[

First

|

Previous

|

Next

|

Last

]

Font:

Proportional Font

LISTSERV Archives

LISTSERV Archives

UVMFLOWNET Home

UVMFLOWNET Home

UVMFLOWNET  January 2009

UVMFLOWNET January 2009

Subject:

Re: Orders (changed subject title)

From:

[log in to unmask]

Reply-To:

[log in to unmask]

Date:

Wed, 28 Jan 2009 11:51:03 -0500

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (199 lines)

Barb,

In general, I agree with Jack.  For Part B claims, the following is the rule (with 
a few <SNIP>s of irrelevant content to comply with listserve length 
requirements).  Also, CMS has "manualized" (have to love that word - from CMS) 
allowing 'conditional' orders (e.g., 'if x is (insert test result), then do y' - 
so something like "do 93922 and if normal do 93924" - maybe translated to 
English?).  The manuals provide  more detailed, and useful (personal opinion) 
guidance.  In general, 'standing orders' are coming under increasing scrutiny - 
with recommendations that physicians review and at least initial them in each case.

/fww

Franklin W. West
BSN, RN, RVT, RVS, FSVU, CHC
Director, Professional Services
Pacific Vascular Inc.
18702 N. Creek Parkway, Suite 212
425.398.7774 (office)
425.486.8976 (fax)
[log in to unmask]
www.pacificvascular.com
www.PVICME.com

********************************
[Code of Federal Regulations]  [Title 42, Volume 2]
[CITE: 42CFR410.32]

TITLE 42--PUBLIC HEALTH
PART 410_SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS--Table of Contents
Subpart B_Medical and Other Health Services

Sec.  410.32  Diagnostic x-ray tests, diagnostic laboratory tests, and other 
diagnostic tests: Conditions.

    (a) Ordering diagnostic tests. All diagnostic x-ray tests, diagnostic 
laboratory tests, and other diagnostic tests must be ordered by the physician who 
is treating the beneficiary, that is, the physician who furnishes a consultation 
or treats a beneficiary for a specific medical problem and who uses the results in 
the management of the beneficiary's specific medical problem. Tests not ordered by 
the physician who is treating the beneficiary are not reasonable and necessary 
(see Sec.  411.15(k)(1) of this chapter).
    (1) Chiropractic exception. <SNIP> 
    (2) Mammography exception. <SNIP>
    (3) Application to nonphysician practitioners. Nonphysician practitioners 
(that is, clinical nurse specialists, clinical psychologists, clinical social 
workers, nurse-midwives, nurse practitioners, and physician assistants) who 
furnish services that would be physician services if furnished by a physician, and 
who are operating within the scope of their authority under State law and within 
the scope of their Medicare statutory benefit, may be treated the same as 
physicians treating beneficiaries for the purpose of this paragraph.
    (b) Diagnostic x-ray and other diagnostic tests--(1) Basic rule. Except as 
indicated in paragraph (b)(2) of this section, all diagnostic x-ray and other 
diagnostic tests covered under section 1861(s)(3) of the Act and payable under the 
physician fee schedule must be furnished under the appropriate level of 
supervision by a physician as defined in section 1861(r) of the Act. Services 
furnished without the required level of supervision are not reasonable and 
necessary (see Sec.  411.15(k)(1) of this chapter).
    (2) Exceptions. The following diagnostic tests payable under the physician fee 
schedule are excluded from the basic rule set forth in paragraph (b)(1) of this 
section:
    (i) Diagnostic mammography procedures, which are regulated by the Food and 
Drug Administration.
    (ii) Diagnostic tests personally furnished by a qualified audiologist as 
defined in section 1861(ll)(3) of the Act.
    (iii) Diagnostic psychological testing services when--
    (A) Personally furnished by a clinical psychologist or an independently 
practicing psychologist as defined in program instructions; or
    (B) Furnished under the general supervision of a physician or a clinical 
psychologist.
    (iv) Diagnostic tests (as established through program instructions) personally 
performed by a physical therapist who is certified by the American Board of 
Physical Therapy Specialties as a qualified electrophysiologic clinical specialist 
and permitted to provide the service under State law.
    (v) Diagnostic tests performed by a nurse practitioner or clinical nurse 
specialist authorized to perform the tests under applicable State laws.
    (vi) Pathology and laboratory procedures listed in the 80000 series of the 
Current Procedural Terminology published by the American Medical Association.
    (3) Levels of supervision. Except where otherwise indicated, all diagnostic x-
ray and other diagnostic tests subject to this provision and payable under the 
physician fee schedule must be furnished under at least a general level of 
physician supervision as defined in paragraph (b)(3)(i) of this section. In 
addition, some of these tests also require either direct or personal supervision 
as defined in paragraphs (b)(3)(ii) or (b)(3)(iii) of this section, respectively. 
(However, diagnostic tests performed by a physician assistant (PA) that the PA is 
legally authorized to perform under State law require only a general level of 
physician supervision.) When direct or personal supervision is required, physician 
supervision at the specified level is required throughout the performance of the 
test.
    (i) General supervision means the procedure is furnished under the physician's 
overall direction and control, but the physician's presence is not required during 
the performance of the procedure. Under general supervision, the training of the 
nonphysician personnel who actually perform the diagnostic procedure and the 
maintenance of the necessary equipment and supplies are the continuing 
responsibility of the physician.
    (ii) Direct supervision in the office setting means the physician must be 
present in the office suite and immediately available to furnish assistance and 
direction throughout the performance of the procedure. It does not mean that the 
physician must be present in the room when the procedure is performed.
    (iii) Personal supervision means a physician must be in attendance in the room 
during the performance of the procedure.
    (c) Portable x-ray services. <SNIP>:
    (1) <SNIP>  
    (2) <SNIP>
    (3) The procedures are limited to--
    (i) <SNIP>;
    (ii) <SNIP> Chest; and
    (iii) Diagnostic mammograms if <SNIP> 
    (d) Diagnostic laboratory tests--(1) <SNIP>:
    (i) A participating hospital or participating RPCH.
    (ii) <SNIP>
    (iii) <SNIP>.
    (iv) An RHC.
    (v) A laboratory, <SNIP>.
    (vi) An FQHC.
    (vii) An SNF <SNIP>
    (2) Documentation and recordkeeping requirements--(i) Ordering the service. 
The physician or (qualified nonphysican practitioner, as defined in paragraph (a)
(3) of this section), who orders the service must maintain documentation of 
medical necessity in the beneficiary's medical record.
    (ii) Submitting the claim. The entity submitting the claim must maintain the 
following documentation:
    (A) The documentation that it receives from the ordering physician or 
nonphysician practitioner.
    (B) The documentation that the information that it submitted with the claim 
accurately reflects the information it received from the ordering physician or 
nonphysician practitioner.
    (iii) Requesting additional information. The entity submitting the claim may 
request additional diagnostic and other medical information to document that the 
services it bills are reasonable and necessary. If the entity requests additional 
documentation, it must request material relevant to the medical necessity of the 
specific test(s), taking into consideration current rules and regulations on 
patient confidentiality.
    (3) Claims review. (i) Documentation requirements. Upon request by CMS, the 
entity submitting the claim must provide the following information:
    (A) Documentation of the order for the service billed (including information 
sufficient to enable CMS to identify and contact the ordering physician or 
nonphysician practitioner).
    (B) Documentation showing accurate processing of the order and submission of 
the claim.
    (C) Diagnostic or other medical information supplied to the laboratory by the 
ordering physician or nonphysician practitioner, including any ICD-9-CM code or 
narrative description supplied.
    (ii) Services that are not reasonable and necessary. If the documentation 
provided under paragraph (d)(3)(i) of this section does not demonstrate that the 
service is reasonable and necessary, CMS takes the following actions:
    (A) Provides the ordering physician or nonphysician practitioner information 
sufficient to identify the claim being reviewed.
    (B) Requests from the ordering physician or nonphysician practitioner those 
parts of a beneficiary's medical record that are relevant to the specific claim(s) 
being reviewed.
    (C) If the ordering physician or nonphysician practitioner does not supply the 
documentation requested, informs the entity submitting the claim(s) that the 
documentation has not been supplied and denies the claim.
    (iii) Medical necessity. The entity submitting the claim may request 
additional diagnostic and other medical information from the ordering physician or 
nonphysician practitioner to document that the services it bills are reasonable 
and necessary. If the entity requests additional documentation, it must request 
material relevant to the medical necessity of the specific test(s), taking into 
consideration current rules and regulations on patient confidentiality.
    (4) Automatic denial and manual review. (i) General rule. Except as provided 
in paragraph (d)(4)(ii) of this section, CMS does not deny a claim for services 
that exceed utilization parameters without reviewing all relevant documentation 
that is submitted with the claim (for example, justifications prepared by 
providers, primary and secondary diagnoses, and copies of medical records).
    (ii) Exceptions. CMS may automatically deny a claim without manual review if a 
national coverage decision or LMRP specifies the circumstances under which the 
service is denied, or the service is specifically excluded from Medicare coverage 
by law.
    (e) Diagnostic laboratory tests furnished in hospitals and CAHs. <SNIP>
**************************************
-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Jack I. Siegel
Sent: Wednesday, January 28, 2009 7:38 AM
To: [log in to unmask]
Subject: Re: PVR's vs duplex

Barb,

That's fine if "your doctors" have a standing order that they would back you up 
during an audit.

Any other physician needs to be contacted to get prior authorization for adding a 
Treadmill, or your lab will get burned if audited.

J2

Jack I.  Siegel, BA RVT
Technical  Director
Vascular Surgery
Dartmouth  Hitchcock Medical Center,  NH
Veterans Administration Medical  Center,   VT
603-650-8145
603-650-4737 fax


To unsubscribe or search other topics on UVM Flownet link to:
http://list.uvm.edu/archives/uvmflownet.html

Top of Message | Previous Page | Permalink

Advanced Options


Options

Log In

Log In

Get Password

Get Password


Search Archives

Search Archives


Subscribe or Unsubscribe

Subscribe or Unsubscribe


Archives

November 2020
October 2020
September 2020
August 2020
July 2020
June 2020
May 2020
April 2020
March 2020
February 2020
January 2020
December 2019
November 2019
October 2019
September 2019
August 2019
July 2019
June 2019
May 2019
April 2019
March 2019
February 2019
January 2019
December 2018
November 2018
October 2018
September 2018
August 2018
July 2018
June 2018
May 2018
April 2018
March 2018
February 2018
January 2018
December 2017
November 2017
October 2017
September 2017
August 2017
July 2017
June 2017
May 2017
April 2017
March 2017
February 2017
January 2017
December 2016
November 2016
October 2016
September 2016
August 2016
July 2016
June 2016
May 2016
April 2016
March 2016
February 2016
January 2016
December 2015
November 2015
October 2015
September 2015
August 2015
July 2015
June 2015
May 2015
April 2015
March 2015
February 2015
January 2015
December 2014
November 2014
October 2014
September 2014
August 2014
July 2014
June 2014
May 2014
April 2014
March 2014
February 2014
January 2014
December 2013
November 2013
October 2013
September 2013
August 2013
July 2013
June 2013
May 2013
April 2013
March 2013
February 2013
January 2013
December 2012
November 2012
October 2012
September 2012
August 2012
July 2012
June 2012
May 2012
April 2012
March 2012
February 2012
January 2012
December 2011
November 2011
October 2011
September 2011
August 2011
July 2011
June 2011
May 2011
April 2011
March 2011
February 2011
January 2011
December 2010
November 2010
October 2010
September 2010
August 2010
July 2010
June 2010
May 2010
April 2010
March 2010
February 2010
January 2010
December 2009
November 2009
October 2009
September 2009
August 2009
July 2009
June 2009
May 2009
April 2009
March 2009
February 2009
January 2009
December 2008
November 2008
October 2008
September 2008
August 2008
July 2008
June 2008
May 2008
April 2008
March 2008
February 2008
January 2008
December 2007
November 2007
October 2007
September 2007
August 2007
July 2007
June 2007
May 2007
April 2007
March 2007
February 2007
January 2007
December 2006
November 2006
October 2006
September 2006
August 2006
July 2006
June 2006
May 2006
April 2006
March 2006
February 2006
January 2006
December 2005
November 2005
October 2005
September 2005
August 2005
July 2005
June 2005
May 2005
April 2005
March 2005
February 2005
January 2005
December 2004
November 2004
October 2004
September 2004
August 2004
July 2004
June 2004
May 2004
April 2004
March 2004
February 2004
January 2004
December 2003
November 2003
October 2003
September 2003
August 2003
July 2003
June 2003
May 2003
April 2003
March 2003
February 2003
January 2003
December 2002
November 2002
October 2002
September 2002
August 2002
July 2002
June 2002
May 2002
April 2002
March 2002
February 2002
January 2002
December 2001
November 2001
October 2001
September 2001
August 2001
July 2001
June 2001
May 2001
April 2001
March 2001
February 2001
January 2001
December 2000
November 2000
October 2000
September 2000
August 2000
July 2000
June 2000
May 2000
April 2000
March 2000
February 2000
January 2000
December 1999
November 1999
October 1999
September 1999
August 1999
July 1999
June 1999
May 1999
April 1999
March 1999
February 1999
January 1999
December 1998
November 1998
October 1998
September 1998
August 1998
July 1998
June 1998
May 1998
April 1998
March 1998
February 1998
January 1998
December 1997
November 1997
October 1997
September 1997
August 1997
July 1997
June 1997
May 1997
April 1997
March 1997
February 1997
January 1997
December 1996
November 1996
October 1996
September 1996
August 1996
July 1996
June 1996
May 1996
April 1996
March 1996
February 1996
January 1996
December 1995
November 1995
October 1995
September 1995
August 1995
July 1995
June 1995
May 1995

ATOM RSS1 RSS2



LIST.UVM.EDU

CataList Email List Search Powered by the LISTSERV Email List Manager