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Order and Refer Eligibility

Source: R/end-opted_out.R
order_refer.Rd

Eligibility to order and refer within Medicare

Usage

order_refer(
  npi = NULL,
  first = NULL,
  last = NULL,
  ptb = NULL,
  dme = NULL,
  hha = NULL,
  pmd = NULL,
  hospice = NULL,
  count = FALSE
)

Arguments

npi

<int> National Provider Identifier

first, last

<chr> Individual provider's first/last name

ptb, dme, hha, pmd, hospice

<lgl> Eligibility for:

  • ptb: Medicare Part B

  • dme: Durable Medical Equipment

  • hha: Home Health Agency

  • pmd: Power Mobility Devices

  • hospice: Hospice

count

<lgl> Return the total row count

Value

A tibble containing the search results.

Criteria

  • Individual NPI

  • Medicare enrollment with Approved or Opt-Out status

  • Eligible specialty type

Types

  • Ordering: can order non-physician services for patients.

  • Referring/Certifying: can request items/services Medicare may reimburse.

  • Opt-Out: can enroll solely to order and refer.

Services

  • Medicare Part B: Clinical Labs, Imaging

  • Medicare Part A: Home Health

  • DMEPOS: Durable medical equipment, prosthetics, orthotics, & supplies

References

Examples

order_refer(count = TRUE)
#> ◼ order_refer | 2,036,207 rows | 408 pages

order_refer(first = "Jennifer", last = "Smith")
#> ✔ order_refer returned 133 results
#> # A tibble: 133 × 8
#>           npi first    last  ptb_ind dme_ind hha_ind pmd_ind hsp_ind
#>         <int> <chr>    <chr>   <int>   <int>   <int>   <int>   <int>
#>  1 1699184895 JENNIFER SMITH       1       1       1       1       0
#>  2 1215919170 JENNIFER SMITH       1       1       1       1       1
#>  3 1053842450 JENNIFER SMITH       1       1       1       1       1
#>  4 1477127207 JENNIFER SMITH       1       1       0       0       0
#>  5 1598994923 JENNIFER SMITH       1       1       1       1       0
#>  6 1467884627 JENNIFER SMITH       1       1       0       0       0
#>  7 1184142903 JENNIFER SMITH       1       1       1       1       0
#>  8 1952073652 JENNIFER SMITH       1       1       1       1       0
#>  9 1821069931 JENNIFER SMITH       1       1       1       1       0
#> 10 1790063832 JENNIFER SMITH       1       1       1       1       1
#> # ℹ 123 more rows