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Home Health Referral Guidelines

Physician Guidelines for Making Home Health Referrals

Guidelines for Coverage of Service

In order to qualify for home health care there are certain conditions that the patient must meet:

• The patient must require the skilled services of a:
- Registered Nurse
- Physical Therapist
- Speech/Language Pathologist

• The patient and/or patient’s caregiver is willing and able to participate in the plan of care.
• Service(s) cannot be exclusively for the purpose of phlebotomy.

• Skilled services are part-time and intermittent.

Agency Requirements
The patient’s residence must be physically adequate for proper patient care and safe for the Home Care staff.

Physician Responsibilities
• Sign Orders:
- Home Health Certification and Plan of Care (HCFA #485): a computer generated document incorporating original orders and clinical assessment. It is required to meet regulatory requirements and to be reimbursed for services. Physician signature is required on this form within 30 days of start of care.

- Change in Plan of Care: is a document that contains previously obtained verbal orders for changes in care. Physician signature is required on this form within 30 days of verbal order.

• Provide alternative physician coverage when not available.