LONG-TERM CARE, PHYSICIAN SUPERVISIONIf the physician's patient is a Medicare or Medicaid beneficiary and is in a long-term care facility, the following applies: "The medical evaluation of the patient is based on a physical examination done within forty-eight (48) hours of admission unless such examination was performed within five (5) days prior to admission. The patient is seen by his attending physician at least once every thirty days for the first ninety days following admission. The patient's total program of care (including medications and treatments) is reviewed during a visit by the attending physician at least once every thirty (30) days for the first ninety days, and revised as necessary. A progress note is written and signed by the physician at the time of each visit, and he signs all his orders. Subsequent to the ninetieth day following admission, an alternate schedule for physician visits may be adopted where the attending physician determines and so justifies in the patient's medical record that the patient's condition does not necessitate visits at thirty -day intervals. This alternate schedule does not apply for patients who require specialized rehabilitation services. At no time may the alternate schedule exceed sixty (60) days between visits." 42 CFR 405.1123 If the physician decides upon an alternate schedule of visits of more than thirty days for a patient, (1) Medicaid must be notified by the facility if the patient is a Medicaid beneficiary; and (2) the utilization review committee must promptly re-evaluate the patient's need for monthly physician visits as well as his or her continued need for skilled nursing facility services. 42 CFR 405.1123 LONG-TERM CARE, PHYSICIAN SUPERVISION |
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