Chapter 28: Physicians/Sources Management

Overview

The Referral Sources module (also called Physicians/Sources Management) manages your network of referring physicians and referral source facilities (hospitals, SNFs, clinics). These contacts are essential for documenting referral sources, ordering physicians, and tracking patient origins.

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Referral Sources Main Page

Page Header

Title: "Referral Sources"

Add Button (Blue):

• Label: "+ Add Referral Source"
• Opens the Add modal (Physician or Facility)
• Always visible (no need to select type first)

Verify from CMS Button (Blue, Outlined):

• Icon: Shield with checkmark (VerifiedUserIcon)
• Label: "Verify from CMS"
• Opens CMS physician lookup modal
• Allows you to search the CMS National Provider Identifier (NPI) registry and import verified physician data
• Only works for physicians (not facilities)

Filters Section

Filter	Type	Options
Search	Text input	Search by physician name, facility name, or NPI
Type	Toggle Buttons	"Physician" (left, blue when selected) or "Facility" (right, blue when selected)

How Type Filter Works:

• Default: "Physician" is selected (shows only physicians)
• Click "Facility" to switch to facilities
• Data table updates automatically to show only the selected type

Data Table

The table displays either physicians or facilities depending on the Type filter:

When Type = Physician

Column	Description	Example
Name	Physician full name (clickable link to detail view)	"Muud abebc", "Nesredin Haji", "Barn Haji"
NPI	National Provider Identifier (10 digits)	"9955779966", "1518405697"
Phone	Physician's primary phone number	"+37267-245-8809", "+372 (123) 456-7..."
Email	Physician's email address	"ghj@gmail.com", "b@b.com"
State	Practice location state (abbreviated)	"FL", "MO"
Status	Badge showing Active/Inactive	Green "Active", Gray "Inactive"
Actions	Icon buttons (View, Edit, Delete)	Eye icon, Pencil icon, Trash icon

When Type = Facility

Column	Description	Example
Facility Name	Name of facility (clickable link)	"St. Mary's Hospital", "Pine Grove Nursing Home"
Type	Facility type	"Hospital", "SNF", "Clinic", "Other"
Contact	Primary contact person	"John Smith, Administrator", "—" (none)
Phone	Main facility phone	"(555) 123-4567"
City, State	Facility location	"Austin, TX", "Miami, FL"
Status	Badge showing Active/Inactive	Green "Active", Gray "Inactive"
Actions	Icon buttons (View, Edit, Delete)	Eye icon, Pencil icon, Trash icon

Action Buttons

Each row has three icon buttons on the right:

Icon	Name	Color	Function
Eye	View	Blue	Opens detail view modal (read-only)
Pencil	Edit	Blue	Opens edit modal (all fields editable)
Trash	Delete	Red	Opens delete confirmation dialog

Pagination

Bottom of table shows page controls:

• Total items count
• Current page number
• Navigation arrows
• Page selector

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Adding a Physician (Manual Entry)

How to Add Manually

1. Click "+ Add Referral Source" button
2. Modal opens with toggle at top: "Physician" (selected) or "Facility"
3. Fill in required and optional fields
4. Click "Save"

Add Physician Modal Fields

Type Toggle (Top)

• Physician (blue button, selected)
• Facility (gray button, inactive)
• Can toggle between types before saving

Required Fields (marked with red asterisk)

Field	Description	Validation
First Name	Physician's first name	Required, text
Last Name	Physician's last name	Required, text

Optional Fields

Field	Description	Validation	Example
NPI	National Provider Identifier	10 digits, numbers only	"1518405697"
Phone Number	Primary phone	Phone format	"+1 (555) 123-4567"
Fax Number	Fax number	Phone format	"+1 (555) 123-4568"
Email	Email address	Valid email format	"doctor@clinic.com"
Address Line 1	Street address	Text	"123 Medical Plaza"
Address Line 2	Apt/Suite	Text	"Suite 200"
City	City	Text	"Austin"
State	State dropdown	Select from list	"Texas"
ZIP Code	Postal code	Text	"78701"
Status	Active/Inactive	Dropdown: "ACTIVE" (default) or "INACTIVE"	"ACTIVE"
PECOS Certified	Checkbox	Checked = Yes, Unchecked = No	☑ Checked

PECOS Certified Field Explanation:

• PECOS = Provider Enrollment, Chain, and Ownership System (CMS registry)
• Check this box if the physician is PECOS-certified (required for Medicare orders)
• Leave unchecked for physicians who don't need Medicare certification

Saving

1. Click "Save" button (blue, bottom right)
2. System validates:
   • First Name and Last Name are required
   • NPI (if provided) must be exactly 10 digits
   • Email (if provided) must be valid format
3. If validation fails, red error messages appear below fields
4. If successful:
   • Modal closes
   • Green toast: "Physician added successfully"
   • New physician appears in table

Cancel

Click "Cancel" (gray button) or "X" (top right) to close without saving.

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Adding a Facility

How to Add Facility

1. Click "+ Add Referral Source" button
2. Modal opens
3. Click "Facility" toggle button at top
4. Form switches to facility fields
5. Fill in required and optional fields
6. Click "Save"

Add Facility Modal Fields

Type Toggle (Top)

• Physician (gray button, inactive)
• Facility (blue button, selected)

Required Fields (marked with red asterisk)

Field	Description	Validation
Facility Name	Full name of facility	Required, text
Facility Type	Type of facility	Required, dropdown: "Hospital", "SNF", "Clinic", "Other"

Optional Fields

Field	Description	Validation	Example
NPI	Facility's NPI (if any)	10 digits	"1234567890"
Main Phone	Facility's main phone	Phone format	"+1 (555) 123-4567"
Fax Number	Facility's fax	Phone format	"+1 (555) 123-4568"
Contact First Name	Primary contact's first name	Text	"John"
Contact Last Name	Primary contact's last name	Text	"Smith"
Contact Title	Primary contact's job title	Text	"Administrator"
Contact Phone	Contact person's direct phone	Phone format	"+1 (555) 123-4569"
Contact Email	Contact person's email	Valid email	"john.smith@hospital.com"
Address Line 1	Street address	Text	"456 Hospital Drive"
Address Line 2	Apt/Suite	Text	"Building A"
City	City	Text	"Houston"
State	State dropdown	Select from list	"Texas"
ZIP Code	Postal code	Text	"77001"
Status	Active/Inactive	Dropdown: "ACTIVE" (default) or "INACTIVE"	"ACTIVE"

Saving

Same validation and toast notification as Physician.

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Verifying a Physician from CMS

What is CMS Verification?

The "Verify from CMS" button allows you to search the CMS National Provider Identifier (NPI) registry to:

• Verify physician credentials before adding them
• Auto-populate physician details (name, NPI, address, phone) from official CMS data
• Ensure accuracy by importing verified information instead of manual entry

How to Use CMS Verification

1. Click "Verify from CMS" button (blue, outlined, shield icon)
2. Modal opens with two tabs: "NPI" and "Name & State"

Tab 1: Search by NPI

Use Case: You have the physician's 10-digit NPI.

Fields:

• NPI - Text input (10 digits)
• Example: "1518405697"

How to Search:

1. Enter the 10-digit NPI
2. Click "Search" button
3. Results appear in table below (if found)

Tab 2: Search by Name & State

Use Case: You don't have the NPI, but you know the physician's name and practice location.

Fields:

• Last Name (required) - At least 2 characters
• First Name (optional)
• State (required) - Dropdown selector

How to Search:

1. Enter Last Name (e.g., "Haji")
2. (Optional) Enter First Name (e.g., "Barn")
3. Select State (e.g., "Missouri")
4. Click "Search" button
5. Results appear in table below

Understanding CMS Search Results

The results table shows:

Column	Description	Example
Name	Physician full name	"Barn Haji"
NPI	10-digit NPI	"1518405697"
Primary Taxonomy	Medical specialty	"Nurse Practitioner"
Phone	Phone number from CMS	"+1 (573) 761-3333"
Address	Full address from CMS	"COLUMBIA, MO 65201-5275"
Actions	"Select" button	Blue button

Empty Cell Indicators:

• "—" (em dash) means no data available in CMS registry

Selecting a Physician from Results

1. Review the results table
2. Find the correct physician
3. Click the blue "Select" button in their row
4. CMS Verification modal closes
5. Add Referral Source modal opens automatically
6. All fields are pre-filled with CMS data:
   • First Name, Last Name
   • NPI
   • Phone Number
   • Address (Line 1, City, State, ZIP)
7. Review the pre-filled data
8. (Optional) Edit any fields
9. Click "Save" to add the physician

Note: You can still edit any field before saving. CMS data is a starting point, not locked in.

Why Use CMS Verification?

✅ Accuracy - Data comes directly from official CMS registry

✅ Speed - No need to manually type name, NPI, address

✅ Compliance - Ensures NPI is valid and associated with correct provider

✅ PECOS Status - Can verify if physician is PECOS-certified

Troubleshooting CMS Search

Issue: "No results from CMS for this NPI"

• Cause: NPI not found in CMS registry
• Solution: Double-check the NPI, or search by name instead

Issue: "No individual providers matched in CMS."

• Cause: Name/state combination didn't match any individual providers
• Solution: Try with Last Name only (remove First Name), or verify the spelling

Issue: "This NPI is an organization."

• Cause: The NPI belongs to a facility/organization, not an individual physician
• Solution: Add it manually as a Facility, not a Physician

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Viewing Physician Details

How to View Details

1. Find the physician in the table
2. Click the Eye icon (View button) in the Actions column
3. Detail view modal opens

Detail View Modal

Mode: Read-only (all fields are grayed out, cannot be edited)

Purpose: Quickly view all physician information without opening edit mode

Fields Displayed:

• All physician fields (name, NPI, phone, email, address, status, PECOS certification)
• Each field shows "—" if empty

Actions:

• Close button (bottom right)
• X button (top right)
• Click outside modal to close

To Edit from Detail View:

1. Close detail view
2. Click the Pencil icon (Edit button) instead

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Editing a Physician or Facility

How to Edit

1. Find the physician/facility in the table
2. Click the Pencil icon (Edit button) in the Actions column
3. Edit modal opens with all current data pre-filled
4. Modify fields as needed
5. Click "Save"

What Can Be Edited

All fields can be edited except:

• Type (Physician vs Facility) - cannot change type after creation
• ID (internal system field)

Editing Best Practices

Updating NPI:

• If you update NPI, verify it's correct (10 digits, valid)
• Use "Verify from CMS" to confirm

Changing Status to Inactive:

• Set Status = "INACTIVE" if the physician retires, leaves practice, or is no longer accepting referrals
• Inactive physicians remain in the system but are hidden from dropdown selectors

Updating Address:

• Update address if physician moves to new practice location
• Ensure state and ZIP code match

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Deleting a Physician or Facility

How to Delete

1. Find the physician/facility in the table
2. Click the Trash icon (Delete button) in the Actions column
3. Confirmation dialog opens:
   • Title: "Confirm Delete"
   • Message: "Are you sure you want to delete [Physician Name]? This action cannot be undone."
   • Buttons: "Cancel" (gray), "Delete" (red)
4. Click "Delete" to confirm
5. Physician/facility is permanently removed

When to Delete

Safe to Delete:

• Duplicate entry (added by mistake)
• Test record from sandbox setup
• Never used in any patient records

NOT Recommended:

• Physician has been used as ordering physician on care orders
• Facility has been used as referral source on patient records
• Historical records need this data

Better Alternative: Instead of deleting, set Status = "INACTIVE". This:

• Preserves historical data integrity
• Hides from dropdown selectors
• Allows you to reactivate later if needed

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Common Scenarios

Scenario 1: Add Physician Who Referred a New Patient

Goal: Add Dr. Maria Rodriguez, who just called with a patient referral.

Solution:

1. Click "+ Add Referral Source"
2. Ensure "Physician" is selected (default)
3. Fill in:
   • First Name: Maria
   • Last Name: Rodriguez
   • Phone Number: (get from her office)
   • (Optional) Ask for NPI and verify from CMS
4. Click "Save"
5. Now available in Patient Admission → Ordering Physician dropdown

Scenario 2: Verify Physician Credentials Before Adding

Goal: Hospital gave you physician's NPI (1234567890). Verify credentials before adding.

Solution:

1. Click "Verify from CMS"
2. Tab: NPI
3. Enter: 1234567890
4. Click "Search"
5. Review results:
   • Name matches expected physician ✓
   • Primary Taxonomy matches specialty ✓
   • Address is correct ✓
6. Click "Select"
7. Review pre-filled data
8. Click "Save"

Scenario 3: Add Referral Source Facility (Hospital)

Goal: Add St. Mary's Hospital as a referral source.

Solution:

1. Click "+ Add Referral Source"
2. Click "Facility" toggle button
3. Fill in:
   • Facility Name: St. Mary's Hospital
   • Facility Type: Hospital
   • Main Phone: (get from hospital)
   • Address: (hospital address)
   • Contact First Name: John
   • Contact Last Name: Smith
   • Contact Title: Discharge Planner
   • Contact Phone: (direct line)
   • Contact Email: john.smith@stmarys.org
4. Click "Save"
5. Now available in Patient Admission → Referral Source dropdown

Scenario 4: Physician Retired, Change to Inactive

Goal: Dr. John Green retired. Stop showing him in dropdowns but keep historical records intact.

Solution:

1. Search for "John Green" in Referral Sources
2. Click Pencil icon (Edit)
3. Change Status = "INACTIVE"
4. Click "Save"
5. Dr. Green:
   • No longer appears in Ordering Physician dropdowns for new patients
   • Remains visible in historical patient records (existing care orders)
   • Can still be viewed/edited in Referral Sources list (filter will show inactive)

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Best Practices

1. Always Use CMS Verification for New Physicians

Why:

• Ensures NPI is valid and matches correct physician
• Auto-populates accurate data
• Saves time

How:

• For every new physician referral, search CMS first
• Only add manually if physician is not found in CMS (rare)

2. Mark Inactive Physicians Instead of Deleting

Why:

• Preserves historical data
• Allows reactivation if physician returns to practice
• Maintains compliance records

How:

• When physician retires/leaves: Edit → Status = "INACTIVE"
• Never delete unless it's a duplicate or test record

3. Add Contact Information for Facilities

Why:

• Facilitates communication with discharge planners, case managers
• Speeds up referral processing

How:

• When adding facility, always fill in:
  • Contact First Name / Last Name
  • Contact Title
  • Contact Phone / Email

4. Verify PECOS Certification for Medicare Patients

Why:

• Medicare requires ordering physician to be PECOS-certified
• Non-PECOS physicians cannot order Medicare home health

How:

• When adding physician who will order Medicare patients:
  • Check "PECOS Certified" checkbox
  • Verify via CMS or ask physician's office

5. Keep Address and Phone Current

Why:

• Fax orders, send reports, coordinate care

How:

• Update physician/facility address if they move
• Update phone/fax if office changes numbers
• Review and update quarterly

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Troubleshooting

Issue: Physician Not Appearing in Dropdown

Symptom: You added a physician, but they don't appear in the "Ordering Physician" dropdown when admitting a patient.

Possible Causes:

1. Status is set to "INACTIVE"
2. Search filter in dropdown is too restrictive
3. Cache issue

Solution:

• Go to Referral Sources → search for physician
• Verify Status = "ACTIVE"
• If inactive, edit and change to ACTIVE
• If active but still not appearing, refresh the page

Issue: CMS Search Returns No Results

Symptom: Searching by NPI or name returns "No results from CMS."

Possible Causes:

1. NPI is incorrect (typo, wrong number)
2. Name is misspelled
3. Physician is not in CMS registry (rare for US physicians)

Solution:

• Double-check NPI or name spelling
• Try searching by Last Name only (remove First Name)
• Try different state if physician practiced in multiple states
• If still no results, add manually (physician may not be CMS-registered)

Issue: Cannot Delete Physician

Symptom: Delete button doesn't work, or error message appears.

Possible Causes:

1. Physician is referenced in existing care orders
2. Permission issue (user lacks delete permission)

Solution:

• Instead of deleting, set Status = "INACTIVE"
• If you must delete (duplicate/test record), contact administrator

Issue: Validation Error When Saving

Symptom: "First name is required" or "NPI must be 10 digits" error appears.

Possible Causes:

1. Required field is empty
2. Field format is incorrect (e.g., NPI has letters)

Solution:

• Red error message appears below the problematic field
• Fill in or correct the field as indicated
• Retry saving

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Permissions and Access Control

Required Permissions

Action	Required Permission	Notes
View Referral Sources List	VIEW_REFERRAL_SOURCES or similar	Without this, menu is hidden
Add Physician/Facility	MANAGE_REFERRAL_SOURCES	Protected button
Edit Physician/Facility	MANAGE_REFERRAL_SOURCES	Protected button
Delete Physician/Facility	MANAGE_REFERRAL_SOURCES or DELETE_REFERRAL_SOURCES	Protected button
Verify from CMS	MANAGE_REFERRAL_SOURCES	Protected button

Role-Based Access Examples

Agency Administrator (Full Access)

• Permissions: All referral source permissions
• Can: View, add, edit, delete, verify from CMS
• Use Case: Maintain referral source database

Admissions Coordinator (View + Add)

• Permissions: VIEW_REFERRAL_SOURCES, MANAGE_REFERRAL_SOURCES
• Can: View, add new physicians/facilities when admitting patients
• Cannot: Delete
• Use Case: Add physicians during patient intake

Clinician (View Only)

• Permissions: VIEW_REFERRAL_SOURCES
• Can: View physician/facility details
• Cannot: Add, edit, delete
• Use Case: Reference ordering physician info when completing OASIS or visit notes

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Integration with Other Modules

Patient Admission (Chapter 14)

• Link: Ordering physician selected from Referral Sources list
• Impact: Must add physician to Referral Sources before assigning to patient

Care Orders (Chapter 15)

• Link: Care Order displays ordering physician and referral source
• Impact: Accurate physician info ensures proper care coordination

OASIS Assessments (Chapter 20)

• Link: OASIS forms include ordering physician (pre-filled from care order)
• Impact: Physician signature workflow depends on accurate physician contact info

Dashboard Widgets (Chapter 2)

• Link: "Pending Physician Signature" widget counts OASIS awaiting physician approval
• Impact: Physician contact info used to send signature requests

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