Posted on Friday, November 18, 2016 7:51 PM
A recent court ruling might lead to a harsher interpretation of a Medicare standard for the timing of obtaining physician signatures.
The current Medicare Home Health Conditions of Participation (CoPs) require patients to be under a physician ordered plan of care and for the physician to certify patient eligibility for home health. The regulation requires agencies to obtain the certification of need for home health services, with physician signature and date, “at the time the plan of care is established or as soon thereafter as possible.” The regulation does not define what “as soon thereafter as possible” means.
Back in September, the U.S. Court of Appeals for the Sixth Circuit reversed an order that dismissed a case against Brentwood, Tennessee-based Brookdale Senior Living. The ruling came to the conclusion that when an agency obtains a certification, where the physician signature is not dated on the exact date of when the plan of care was established, the agency must clarify the reason for the delayed signature.
Your agency needs to take the following actions:
• Document the initial transmission of the 485 to the physician
• Follow-up with the doctor if a signed response is not received within a day or two
The court did not explain what constitutes an acceptable justification, but made it known for an agency to contact the physician and obtain the needed signatures to justify a delay.
For the full article, please see the November 21, 2016 Home Health Line Edition.
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