How to Refer a Patient to Home Nursing & Therapy Services

Who can refer a patient to home care?

An M.D., D.O., or Podiatrist can refer a patient to home care.

Can I refer a patient by calling the agency?

Yes.

Call the referral line at (210) 822-8807

We will need the following information:

  • Name, address, and phone number
  • Social Security number and Date of Birth
  • Health Insurance Information
  • Emergency Contact Information
  • Name of ordering physician
  • Primary reason for home health

Can I fax a referral?

Yes.

A referral can be faxed to the Home Nursing and Therapy Services by completing the referral form and faxing it to (210) 822-8863. If you have questions do not hesitate to call (210)822-8807.

Face-to-Face Encounter Physician Guidance/Care Plan Oversight

Due to the requirements in accordance with the Affordable Care Act, CMS issued a final regulation that requires a home health patient to have a Face-to-Face encounter with the physician that orders or refers Medicare home health services.

What is an encounter?

  • The face-to-face encounter is an in-person visit that occurs between the certifying physician or collaborative non-physician practitioner (nurse practitioner, clinical nurse specialist or a supervised physician’s assistant) and the patient home health services are being ordered for.
  • The encounter MUST be related to the primary reason pt. is needing home health services.

When does an encounter have to take place?

no more than 90 days prior to the home health start of care date OR

  • (90 days prior to the start date of home health services OR)
  • Within 30 days after home health has started services.

What documentation is required?

  • Date of face-to-face encounter
  • Medical condition which justifies primary reason for home health
  • Clinical findings of the encounter that support home health need
  • Clinical findings of the encounter that support homebound status of patient
  • Medicare considers the person homebound if:
    1. There exists a normal inability to leave the home and
    2. Leaving home requires a considerate and taxing effort
  • Physician signature AND date
  • Under the care of a physician, OR Receiving services under a plan of care established and periodically reviewed by a physician AND in need of skilled services

Did you know that Care Plan Oversight (CPO) reimbursement allows physicians to bill Medicare for their time overseeing the care of home care patients?

You may bill for 30 minutes of care plan oversight a month, including medical decision making, review of charts, reports, or treatment plans; review of lab or study results that weren’t ordered during or associated with a face-to-face encounter; phone calls to other health professionals involved in the care of the patient, phoning in prescriptions, and other items on the home care patient’s behalf. Code for care plan oversight is: G0181 for home health.

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