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July/August 2013

Telephone and Verbal Orders - How to keep our patients safe

NCH allows telephone orders with read back (TORB) and verbal orders with read back (VORB) between physicians and clinicians. A VORB is done when the physician is on the floor and gives an order directly to the clinician. Verbal orders should only be given in very rare instances, such as during a code or if the physician is scrubbed and unable to enter the order directly or use pen and paper. A TORB is given remotely, and should be used only for urgent needs.

Why the need to carefully differentiate TORB and VORB? There are legal and compliance issues related to their use that makes them distinctly different. A VORB essentially means you were present very close to the patient's bedside; this may be important when trying to piece together an occurrence at a later date. All VORBs must be signed by the physician who gave the order BEFORE THE PHYSICIAN LEAVES THE CLINICAL area. There is no allowance for signing the next day, and physician partners are not to sign verbal orders. This is in accordance with Illinois state law and Illinois Medicaid rules. Telephone orders may be signed by any physician caring for the patient during the encounter, including but not limited to the ordering physician's partners, and must be signed no later than 72 hours after the order is given.

What is the effect on admitting orders given as either a TORB or VORB? Admitting orders are under close scrutiny by Illinois Medicaid, Medicare, and other payer sources. Technical denials of whole admissions because the order was not signed in a timely fashion by the correct clinician can and have resulted in denying the whole claim. If a claim is denied, this not only results in no payment to the hospital for the entire stay, but invalidates the physician services that occurred and can result in denial of physician payment. Some entities, particularly Medicare and Medicaid, will do retrospective reviews up to three years after the claim and then demand back payment at that time. Thus, being paid now does not mean the hospital and the physician will not find themselves paying back their fees as long as three years later.

Questions or concerns? Feel free to contact Panayota Kleinman, MD Director, Medical Services, at or 847.618.5685.

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Last Updated 2013/08/07