A court order is an example of a non-physician referral. A family member may not refer a patient. First, the time must be reasonable. You cannot bill for services that are provided in the group home. Only components of a PHP are billable to Medicare.
Some clients take months to treat.
A reasonable length of stay depends on your documentation. Your plan of treatment should justify the need for the client to remain a part of the program. Yes, the physician must be present if the services are provided offsite. The nursing home must provide this information to you. Also, this information must include why the nursing home cannot provide the services.