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Printed Date: 9/22/2015
As of January 1, 2015, the certifying physician and/or the acute/post-acute care facility medical record (if the patient was directly admitted to home health) for the patient must contain information that justifies the referral for Medicare home health services. The following should be documented and shared with the home health agency:
Order for Home Health Services
The orders must indicate the types of services to be provided to the patient, both with respect to the professional who will provide them and the nature of the individual services, as well as the frequency of the services.
Documentation to Support Homebound Status – Two criteria:
Documentation to Support the Need for Intermittent Skilled Services
Face-to-Face Encounter Documentation
You are responsible for all claims that you submit or cause to be submitted to the Medicare Program. Medicare assumes that every claim you submit or cause to be submitted is for something that you determined to be medically necessary. Submitting false claims or causing false claims to be submitted can subject you to civil or criminal penalties, and can have consequences on your medical license and ability to bill Medicare. False claims include claims where the service is not supported by the patient’s medical record.
This document was developed through the A/B Medicare Administrative Contractor Provider Outreach and Education Collaboration Team. This joint effort ensures consistent communication and education throughout the nation on a variety of topics and assists the provider and physician community with information necessary to submit claims appropriately and receive proper payment in a timely manner.
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Last Updated: 05/23/2019