Prior Authorization : Plan of Care

Physician Verbal Orders

At times, the physician may give an order verbally.

Verbal Orders for Initial Certification

Verbal orders may be obtained from the attending physician for the initial certification period; however, the attending physician is required to sign and date the POC within 20 working days of the start of care date. To facilitate immediate access to home care services, Wisconsin Medicaid allows home health and PDN providers to be reimbursed for services provided under verbal orders. The provider is required to reduce the verbal orders to writing, transmit the orders to the physician immediately, and obtain the physician's signature and date on those orders within 20 working days.

Verbal Orders for Subsequent Certification

Once care has started, verbal orders may not be obtained for subsequent certification periods. For ongoing cases, the physician must review, sign, and date renew or (as necessary) revise orders before the end of the certification period for the provider to continue to be reimbursed without interruption after starting care of the member.

The attending physician is required to sign and date the POC prior to the provision of services to the member.

Verbal Orders Within Any Certification Period

An urgent situation may prompt the physician to issue verbal orders. Such verbal orders during the authorized certification period are the direct result of changes in the patient's condition necessitating an immediate modification to the POC. For example, the member's adverse reaction to a currently prescribed medication or treatment may result in a physician verbally ordering a change to the member's treatment or medication.

When verbal orders are necessary within a certification period, the provider must document the orders, reduce them to writing, and sign and date them. The provider has 10 days from the date the physician gave the orders to obtain the physician's signature and date on those orders.