Physician Certification Requirements

Physician Certification Requirements

Specific Requirements Related to Physician Signature for MedicalNecessity:

• The physician signature is required for the initial IFSP, annual IFSP and anytime a service is added or services change (as determined through the IFSP Review process). For example, physician signatureis

•Required when adding assistive technology if it can be reimbursed by family’sinsurance

•Required when increasing or decreasing frequency ofservices

•Not required when the service location changes from one natural environment toanother

•Not required when ending aservice

•Not required when adding an assessment for children covered byMedicaid

• The physician signature must be dated by thephysician.
• Thephysiciancertificationof theIFSPisconsideredapartof theIFSPandmustbeattachedtotheIFSP. MedicalnecessityisestablishedbytheIFSPcombinedwithphysiciancertification.
• TheIFSPmust becertifiedasawhole(i.e.it isnotacceptabletohavemorethanoneindividualoragencyobtaincertificationforindividualservicesontheIFSP).Thelocalsystem/ServiceCoordinatorisresponsibleforassuringthatthephysiciancertifiestheIFSPandthatthephysiciancertificationisapart oftheIFSPdocument.Thelocalsystemmaydelegatethisprocess,but onlytooneindividual/agencysothat physiciansreceiveonlyonerequestforreviewandcertificationoftheIFSPasawhole.Ifthisresponsibilityisdelegatedtoanindividual/agency,that individual/agencymustsendthesigneddocumenttothelocalsystemtobefiledwiththeIFSPinthechild’sEI record.
• Servicecoordinatorsareexpectedtomakeeveryefforttoobtainphysiciancertificationquicklyenoughtoensurethetimelystart of services.Localsystemsarenotpermittedtodelaythestart ofsupportsandserviceswhilewaitingforinsuranceauthorizationor physiciancertification, exceptbyparentrequest.Ifthereisdifficultyingettingtimelyphysiciansignaturefromthechild’sprimarycarephysician, servicecoordinatorsmayseekasignaturefromanotherphysicianonthechild’smedicalteam orIFSPteamormaybeabletogetthesignatureofaphysicianassistantornursepractitionerassociatedwiththephysician.
• Inthoserareinstances whentheservicecoordinatorisunabletoobtainthephysiciansignatureinatimelymanner,Part Cfundsmustbeused, asneeded,toavoidadelayinthestart of services.RememberthatMedicaidallowstheservicetostart withoutaphysiciansignatureandwillstillreimbursefortheserviceaslong asthephysician(orphysicianassistant ornursepractitioner)signatureisobtainednomorethan30daysafterthefirstIFSPservices(otherthanservicecoordination)begin.
• PhysicaltherapistsmustfollowVirginiaPTregulatoryrequirementsgoverningphysicianreferralsforservicesandwillnot beabletobeginserviceswithoutsuchareferral, exceptunderthelimitedexclusionsspecifiedinthePTregulations,evenif PartCfundsareavailableaspayoroflastresort.

Physician Signature Needed atIFSP Review…

• Iftheprojected enddatehasbeenreachedandthe service will continue? Yes
• Ifa newservice (otherthan assessment,forchildren with Medicaid),isadded?Yes
• Ifthere isa change(increase ordecrease)infrequencyorlengthofan existing service? Yes
• Ifa service ends? No
• Ifthechild is dischargedfromearly intervention? No
• Ifservices staythesamebutan outcome(s)and/orshorttermgoal(s)changes?No
• Iftheonlyentitledearly interventionservice listed ontheIFSP isservice coordination? No

Supplemental Handout for Webinar Promoting Effective and Efficient Fiscal Management Part III 7.29.15