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PA signature not enough, need physician.


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I work in outpatient orthopedics and as you would expect, I see patients on my own and give out a variety of prescription including medications, MRIs, PT, etc. Recently, I've had an issue with some patients who have MPI insurance (motion picture industry) which is a decent amount of patients as I am in Los Angeles. My PT prescriptions are being kicked back, saying they need a physician signature on both the prescription and my chart note. This is completely ridiculous and a waste of time for both me and my SP. I see nearly all post-op patients with no issues, and they all need PT. Is there anything I can do about this? Reach out to my state PA board or to AAPA? I am a member of both. Thanks.

Another issue that doesn't affect me directly but is still annoying, is that the hospital we do some surgeries at requires a physician signature on the patient pre-op medical clearance. They are okay with a PA doing the clearance, but need a physician signature on the paper as well.

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Call the clinic manager.  Let them know you are going to be sending your patients to their competition because of this.  Point out that your orders are legal, and if they have any doubt on that, they should consult their own lawyers.

This should work for both the PT and preop, but requires your clinic to be OK with you referring elsewhere.

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3 hours ago, rev ronin said:

Call the clinic manager.  Let them know you are going to be sending your patients to their competition because of this.  Point out that your orders are legal, and if they have any doubt on that, they should consult their own lawyers.

This should work for both the PT and preop, but requires your clinic to be OK with you referring elsewhere.

I think the issue he is having is not with the PT clinic, but with the particular insurer who is refusing to cover the PT referrals without physician co-signature.

I'm not familiar with CA prescribing laws, but I gather it must be legal for a PA to refer to PT without co-signature, since you only mention having the issue with the one insurer. Maybe your admin people can reach out to them and try to figure out what the issue is?

Then again, sometimes prescribing laws are just stupid. I mean, in Washington I can write for Dilaudid and sign death certificates (hopefully not for the same patient!), but I can't write for diabetic shoes. Makes no sense. 

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Only two ways to fix this

1. Like Rev suggests, find a way to hit someone in the pocketbook

2. Be the squeaky wheel. Have office staff, patients, and every other willing party call and complain. If you occupy enough of their staff time they will decide this policy is costing too much in terms of time and resources.

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I had a similar problem with an insurer in my rural area who wouldn't even let me on the panel because it was "full". Only one clinic in town was on their panel and the next closest provider was 20 miles away. Their answer? They can drive 20 miles if they need to. 

I called the 3 largest employers in the area HR department and then followed up with a letter. They all called their reps and I was credentialed. Pocketbook and squeaky wheel in one solution.

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On 8/28/2017 at 0:12 AM, AbeTheBabe said:

Yes, it's only that specific insurer. I have talked to the credentialing lady at work, and she said she would look into it. Let's see if anything happens. If nothing comes of it, I guess I will try to reach out to CAPA.

Hi AbeTheBabe, 

Is this a Hill's Physicians problem? I work in the Bay Area and have the same issue.  They require an MD or DO to sign referrals for PT.  PAs and NPs can't do it, nor can we be listed as the PCP.  It's ridiculous.  It's the only insurance co. my practice has had issues with.

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On 9/4/2017 at 5:17 PM, Sarahava said:

Hi AbeTheBabe, 

Is this a Hill's Physicians problem? I work in the Bay Area and have the same issue.  They require an MD or DO to sign referrals for PT.  PAs and NPs can't do it, nor can we be listed as the PCP.  It's ridiculous.  It's the only insurance co. my practice has had issues with.

Nope, I haven't heard of that insurer. The insurance I have a problem with is MPI, which is for the motion picture industry.

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