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RIVERVIEW MEDICAL CENTER

A DIVISION OF MERIDIAN HOSPITALS CORPORATION

MEDICAL STAFF POLICY

TITLE: REFERRING PRACTITIONERS

ORDERING OUTPATIENT SERVICES Policy # 24

EFFECTIVE DATE: January 2014 PAGE 1 OF 2

POLICY: Requirements for Ordering Hospital Outpatient Services: Outpatient services in hospitals may be ordered (and patients may be referred for hospital outpatient services) by a practitioner who is:

 Responsible for the care of the patient;

 Licensed in, or holds a license recognized in the jurisdiction where he/she sees the patient;

 Acting within his/her scope of practice under State law; and

 Authorized by the medical staff to order the applicable outpatient services under a written hospital policy that is approved by the governing body. This includes both practitioners who are on the hospital medical staff and who hold medical staff privileges that include ordering the services, as well as other practitioners who are not on the hospital medical staff, but who satisfy the hospital’s policies for ordering applicable outpatient services and for referring patients for hospital outpatient services.

The following outpatient departments may only accept orders for services from practitioners with medical staff privileges: Surgical Day Stay, Medical Day Stay, Interventional Radiology, Radiation Therapy/Cyberknife, and Outpatient Dialysis.

PROCEDURE:

1) If the practitioner IS currently a member of the Medical Staff at Meridian Health, primary source license verification is NOT required to be done by the Outpatient Department since the practitioner has been fully credentialed through the Medical Staff Services Department.

2)  To check if a practitioner is a member of one of the Meridian Medical Staffs they should go to the Physician Directory on the Intranet. http://intranet.meridianhealth.com/

3) If the Practitioner is NOT a member of one of the Meridian Medical Staffs, the license of the ordering practitioner needs to be primary source verified using the New Jersey Division of Consumer Affairs telephone license verification line as follows:

·  Dial the number 973-273-8090

·  Select option 2

·  Select option 2

·  Enter the first two alpha letters of the license

·  When you have confirmed that you have entered the correct ALPHA code, press the # key.

·  Enter the numeric license number and press the #key

·  You will be asked to confirm the name of the practitioner. If confirmed, press 1

·  A recording will repeat the license number and tell you the status and expiration date of the license. Only a status of ACTIVE is acceptable.

a)  Documenting the verification :

·  If you want a hard copy verification, press 1 and enter the fax number.

·  If you do not want a hard copy verification, you will need to document and maintain at a minimum the following:

ü  Method of verification (telephone verification line)

ü  Date and time of the verification

ü  Status of the license

ü  Expiration date of the license

ü  Name and title of the person verifying the license.

NOTE: The telephone verification line also tells you whether or not the licensee has had any disciplinary actions. As long as the license is in an “Active” status, the disciplinary actions are not relevant for the purposes of this query.

4)  If the practitioner is licensed in a state other than NJ, you should do the following:

  1. During normal business hours, (Monday-Friday, except observed holidays, 7:30am to 5:00pm) contact the Medical Staff Office at 732-530-2440 (internally 660-2440 or ext 2440). A verification will be done and the information provided to the caller.
  2. After normal business hours the following internet site will take you to any licensing board in the country. You should document or maintain the hard copy verification as stated above.

http://www.noah-health.org/en/usmd/state.html

5) Medicare/Medicaid Exclusions: To check if a practitioner, who is not a member of one of the Meridian Medical Staffs, is excluded from Medicare or Medicaid programs go to US Department of Health & Human Services/Office of Inspector General (OIG) website http://exclusions.oig.hhs.gov/ and do a search of the practitioner’s last and first name.

Also, if the practitioner is licensed in NJ, you must also do a search of the NJ Consolidated Debarment Report. http://www.state.nj.us/treasury/debarred/debarsearch.htm