Medicare Documentation Authorization for Home Health

[andersenpa]

Need some feedback from you all.

I have come across a conflict in signature authorization. State statute for me (WA state) allows signature on any documents requiring physician signature.

 

The Home Health certification through Medicare guidelines require a physician. My hospital is telling me that they feel the "intent" of the guideline is physician only. My read of the CMS guideline allows a doc or authorized nonphysician provider (NPI identified?) to perform the signature.

 

Any exposure to this for any of you?

 

Thanks

Matt

[rcdavis]

I think this has been asked and answered at the CMS level

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1219.pdf

Hope this helps buddy

rc

[andersenpa]

I was reading this earlier today actually

The text leaves some things open to interpretation, I think this is the source of confusion

 

at one point it states

"Documentation must be clearly titled, dated, and signed by the certifying physician, whether as part of the certification form itself, or as an addendum. It must also include the date the face-to-face encounter was performed. "

 

and then it goes on to say PAs can perform the face to face encounter:

 

"NPPs allowed to perform the face-to-face encounter include.....A physician assistant under the supervision of the certifying physician. "

 

I'll update what I hear.

Anyone else experience something similar?

[ventana]

Gotta be a doc certifying

in my area they have to have a doc signature on everything which I believe to be overkill

but ONLY a doc may certify homebound

 

we have got to get this changed. NP are working it. Talk. To your congress people to get this silly rule overturned

[ATCLATEMTB]

I have run across this a couple of times, currently here is my strategy. (I work in CV Surgery)

 

On all progress notes on the patients last day in hospital I outline the home care to be provided. Most recently, I have had issues with home Oxygen. Apparently, Medicare requires you to review the Home O2 study, and sign, as well as a CMN with signature, and Rx for home O2. I now write something like the following:

 

Dispo: pt to be discharged home today, with Home O2. HOME O2 STUDY DATED xx/xx/xxxx: with personal review of home study patient meets requirements for home oxygen supplementation, based on SpO2 at xx at rest and xx with activity. The utilization of home O2 at 2LPM NC at rest and 3 LPM with activity is thus prudent in light of patients oxygen saturations.

 

I then forward this note onto my SP who also signs the note. So far that has kept the O2 issues down, still have CMN faxed to office for completion. As far as the rest of the equipment, I barely if ever order anything for home use outside oxygen, and reject any Rx orders for things like bedside commodes.

[ventana]

two different issues here

 

1- must be a DO or MD to order home care

 

2- to order O2 you have to document desat (with or with out exercise) and correction to above 92% with O2 and resolution of DOE/SOB - have to have % in there.....

[andersenpa]

Gotta be a doc certifying

in my area they have to have a doc signature on everything which I believe to be overkill

but ONLY a doc may certify homebound

 

we have got to get this changed. NP are working it. Talk. To your congress people to get this silly rule overturned

 

Jeff, after I did my homework I found this out

Thanks for the information- I actually figured you would be one of the forum members who would know this!

Doc/PA/NP can do the Face-to-face visit but ONLY doc can sign/certify

 

The link from CMS:

 

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1219.pdf

 

I called WAPA (my state chapter) and spoke to one of our board members. The bill is in committee to enable PA signature but she says it will die due to the fiscal cliff activity, and will have to be reintroduced.

 

Current bill information:

 

http://www.govtrack.us/congress/bills/112/s227

[bondsteveen]

fdg df fdg fg

[bondsteveen]

Recently, I admitted my grandmother in hospital by for health problems. After discharged my grandmother, I asked for home care services to serve my grandmother. They said about Medicare Documentation which is really needed when we want a home care service. I doesn't have enough information about Medicare documentation, So anyone know about this topic, Please produce some information.

 

in home care

[ventana]

Recently, I admitted my grandmother in hospital by for health problems. After discharged my grandmother, I asked for home care services to serve my grandmother. They said about Medicare Documentation which is really needed when we want a home care service. I doesn't have enough information about Medicare documentation, So anyone know about this topic, Please produce some information.

 

in home care

 

???? admitting your own grandmother - huge conflict of interest if you are providing care to your grandmother - REALLY need to have someone take over for you

 

as for homecare

 

look at the tag line web site as I have some info on it on my page

 

just google it and a ton-o-info comes up

[johnstephen1]

Recently, I admitted my grandmother in hospital by for health problems. After discharged my grandmother, I asked for home care services to serve my grandmother. They said about Medicare Documentation which is really needed when we want a home care service. I doesn't have enough information about Medicare documentation, So anyone know about this topic, Please produce some information.

 

in home care

 

Same problem has faced by my friend's mother near about one year ago. There after they decided to take the advantages of Mashomecare services.

Now no problem is heard from there.