Referral of Patients and Ordering of Services/Items
Physicians sometimes need to refer patients for specialized medical care or to receive certain diagnostic tests or supplies. In such cases, physicians should consider the following:
* Implement a process to ensure that only the ordered services or tests were rendered. For example, when reviewing the results of diagnostic tests, note whether the other provider performed additional or more complex tests than those ordered. The ordering physician ’ s PIN must be protected against misuse.
* Whenever possible, specify the reason for ordering the services. If diagnostic tests are ordered as part of a routine physical exam, include that fact with the referral. Physicians should not em- power the other provider who files the Medicare claim to determine why the tests were needed.
* Never sign blank certification forms that are used by other providers to justify Medicare payment for oxygen, home health services, wheelchairs, hospital beds, prosthetic devices, etc. Be sure to personally complete all medical information on such forms. Demographic information, such as patient name and address should be fully completed by the supplier or physician.
* Medical services, supplies, and devices are sometimes aggressively marketed to beneficiaries, with little regard for the medical condition, examples include: transcutaneous electrical nerve stimulator devices and power operated scooters. While these devices are helpful for some beneficiaries, physicians should use extreme caution when prescribing or ordering them, due to the creative ways they are sometimes marketed. Medicare can pay for items or services that are medically necessary. Certification forms include helpful information about eligibility for the service or product being prescribed.
* Where applicable, specify the quantity of medical supplies or the duration of services needed for a patient. An open-ended certification is like giving someone a blank check. Recent cases show Medicare being billed by suppliers providing items that were, in fact, certified by a physician but delivered in staggering quantities.
* Be suspicious of offers, discounts, free services, or cash to order services. If a deal sounds too good to be true, it probably is. Physicians should contact the OIG or a healthcare attorney if they believe a business arrangement places them at risk. The penalties for violating Medicare ’ s Anti- Kickback Statutes can be severe.
* Never certify the need for medical services or supplies for patients who have not been seen and examined.
