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Tip From The Trenches

Date Published: April 03 2013

What is the Prior Authorization process when a patient requires an OT/PT evaluation?

When a patient requires an OT/PT power mobility device evaluation, there are two scenarios and outcomes: 

Scenario one:

The patient sees the Primary Care Physician before they see the OT/PT:

1) The patient goes to their Primary Care Physician.

2) The PCP uses DMEevalumate.com to complete the face-to-face evaluation and seven-element order and refers the patient for an OT/PT evaluation.

3) The OP/PT writes the evaluation and sends it to the PCP.

4) The PCP writes a new seven-element order and signs the OT/PT evaluation (dated the same day).

5) The new seven-element order, OT/PT evaluation and DMEevalumate.com face-to-face documentation are all sent to the DME provider.

6) The DME provider creates and sends detailed product order to the physician for signature.

7) The DME provider submits all completed paperwork to Medicare for approval.

Scenario two:

The patient sees the OT/PT before they see the PCP:

1) The PCP writes an order for the patient to see an OT/PT.

2) The OT/PT sees the patient and writes an evaluation.

3) The OT/PT sends the evaluation to the PCP, who signs it.

4) The patient visits the PCP who completes the face-to-face evaluation and seven-element order using DMEevalumate.com.

5) The PCP sends the signed OT/PT evaluation and the DMEevalumate.com produced face-to-face evaluation and seven-element order to the DME provider.

6) The DME provider creates and sends detailed product order to the physician for signature.

7) The DME provider submits all completed paperwork to Medicare for approval.

This information is brought to you by DMEevalumate.com Tips from the Trenches, in response to FAQs from our customers. For more information, contact us at info@dmeevalumate.com.

#Medicare #Prior Authorization #Rehab and Assistive Technology #Referring Physicians #DME Billing

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