How to Refer Patient

How to Refer Patients to Cardiac or Pulmonary Rehabilitation:

  Referring patients in a timely manner to cardiac and pulmonary rehabilitation is important to both the patient's physical and mental healing. Often after a cardiac or pulmonary event, procedure, or new diagnosis, patients are processing a large amount of new information that involve many new changes in their life.  It can be a very stressful mental time for many who are already physically recovering.  Cardiopulmonary rehabilitation provides the needed support after major events in their life and improves not only the short term daily life, but increases the likelihood of making long-term, lifestyle changes. 

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Every facility varies in a degree how they handle patient referrals, but in order to start the process in an efficient manner, please use the following as a basic guide:

Qualifying Diagnoses for CR & PR: CMS Qualifications

** Always Check with Insurance for pre-approval of service - some insurances may cover events/procedures not listed here **

Cardiac Rehab: 

** Diagnoses Must Be Documented **

• MI (STEMI or N-STEMI) - within 12 months of event
• Valve Surgeries (repair or replacement)
• CABG
• Percutaneous Transluminal Coronary Angioplasty (PTCA) 
• PCI - Coronary Stent Placement
• Stable Angina Pectoris
• Heart/Heart-Lung Transplant
• Stable CHF with Reduced EF - Class II to IV despite optimal medical management, EF 35% or less 

Pulmonary Rehab: 

** Medicare Part B covers PR for individuals who meet the following criteria **

• COPD 
• Other Chronic Lung Diseases that significantly impair breathing
• Post-Covid (symptoms for at least 4 weeks after confirmed os suspected COVID-19)
• Moderate to Severe Chronic Lung Disease that affects daily activities (Non-COPD/Other Respiratory Ailments covered for Respiratory Therapy Services

In-patient Referral:

** Only Physicians May Sign Orders for Cardiac or Pulmonary Rehabilitation ** 

If order exists in your hospitals EMR system:  Be sure to select the order/referral to cardiac or pulmonary rehab for the patient prior to discharge.  This will allow your facility to start the process of the patient's enrollment in rehab in a timely manner.  Often times, if an order is received while the patient is still in the hospital, a staff from rehab may be able to come and speak with the patient in-person.  

If order does NOT exist in hospital's EMR system:  Be sure to contact your local cardiopulmonary rehabilitation, and send any necessary records, to make them aware of the patient referral.  Once they have the patient information and referral, the enrollment and planning process for their rehab can begin.  

Discharged/Outpatient Referral:

If the patient has already been discharged from the hospital, or you are referring from an outpatient setting, reach out to your local CR or PR to ensure that the referral process is started.  They can guide you through their program specific procedures to get your patients started as soon as able. 

The current list of CR & PR in Arkansas is listed in the link below: