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Order and Refer Eligibility

Source: R/cms-order_refer.R
order_refer.Rd

Eligibility to order and refer within Medicare

Usage

order_refer(
  npi = NULL,
  first = NULL,
  last = NULL,
  part_b = 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

part_b, dme, hha, pmd, hospice

<lgl> Eligibility for:

  • part_b: Medicare Part B

  • dme: Durable Medical Equipment

  • hha: Home Health Agency

  • pmd: Power Mobility Devices

  • hospice: Hospice

count

<lgl> Return the dataset's total row count

Value

A tibble

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` returned 2,001,856 results.
order_refer(npi = 1003026055)
#> ✔ `order_refer` returned 1 result.
#> # A data frame: 1 × 8
#>   first   last   npi        part_b dme   hha   pmd   hospice
#> * <chr>   <chr>  <chr>      <chr>  <chr> <chr> <chr> <chr>  
#> 1 RADHIKA PHADKE 1003026055 Y      Y     Y     Y     Y      
order_refer(first = "Jennifer", last = "Smith")
#> ✔ `order_refer` returned 135 results.
#> # A data frame: 135 × 8
#>    first    last  npi        part_b dme   hha   pmd   hospice
#>  * <chr>    <chr> <chr>      <chr>  <chr> <chr> <chr> <chr>  
#>  1 JENNIFER SMITH 1922290519 Y      Y     Y     Y     Y      
#>  2 JENNIFER SMITH 1881115061 Y      Y     N     N     N      
#>  3 JENNIFER SMITH 1700809498 Y      Y     Y     Y     N      
#>  4 JENNIFER SMITH 1215919170 Y      Y     Y     Y     Y      
#>  5 JENNIFER SMITH 1497981047 Y      Y     N     N     N      
#>  6 JENNIFER SMITH 1669767083 Y      Y     Y     Y     Y      
#>  7 JENNIFER SMITH 1396366811 Y      Y     Y     Y     Y      
#>  8 JENNIFER SMITH 1811732217 Y      Y     Y     Y     N      
#>  9 JENNIFER SMITH 1497270268 Y      Y     Y     Y     N      
#> 10 JENNIFER SMITH 1386871028 Y      Y     Y     Y     Y      
#> # ℹ 125 more rows
order_refer(
  part_b = TRUE,
  dme = TRUE,
  hha = FALSE,
  pmd = TRUE,
  hospice = FALSE)
#> ✔ `order_refer` returned 51 results.
#> # A data frame: 51 × 8
#>    first    last        npi        part_b dme   hha   pmd   hospice
#>  * <chr>    <chr>       <chr>      <chr>  <chr> <chr> <chr> <chr>  
#>  1 ROBYN    AYER        1659094290 Y      Y     N     Y     N      
#>  2 MEGAN    BAUMGARDNER 1023796711 Y      Y     N     Y     N      
#>  3 KRISTINA BERRY       1295461192 Y      Y     N     Y     N      
#>  4 BONNIE   BETTS       1306821129 Y      Y     N     Y     N      
#>  5 LAURA    BOBROWSKI   1013297019 Y      Y     N     Y     N      
#>  6 LISA     CHRISTIAN   1235636697 Y      Y     N     Y     N      
#>  7 TRAVIS   DANIEL      1134813934 Y      Y     N     Y     N      
#>  8 LYNELL   DAWSON      1962852533 Y      Y     N     Y     N      
#>  9 BETH     DETRICH     1124364203 Y      Y     N     Y     N      
#> 10 BRIDGET  DIETZ       1720522592 Y      Y     N     Y     N      
#> # ℹ 41 more rows