casemangers: do you call the md every recert?

[kembers]

i just got a job with a home health agency as an rn case manager and i've gotten minimal training. at the end of my assessments after you go over teaching it will ask if you had a conference with the md and if so any new orders.. (usually to keep PT OT HHA going) looking at everyone elses previous assessments it seems they all said yes and the new order is to continue therapy or OK to discharge, just general depending on the assessment.. but doing 4 or 5 patients a day I cant imagine any md wants to be bothered with this kind of order... so i dont know if they actually call or if the 60 day conference gets faxed and that was the md getting notified.. im just wondering what other people do basically.

[LadyT618, MSN, APRN, NP]

Every 60 days, same rules apply as they did at the start of care....approval of orders must be received prior to proceeding with Plan of Care. Here are some excerpt from the Medicare Policy Benefit Manual and the federal tags for review:

30.2.5 - Use of Oral (Verbal) Orders

Services that are provided in the subsequent 60-day episode certification period areconsidered provided under the plan of care of the subsequent 60-day episode where thereis an oral order before the services provided in the subsequent period are furnished andthe order is reflected in the medical record. However, services that are provided afterthe expiration of the plan of care, but before the acquisition of an oral order or a signedplan of care are not considered provided under a plan of care

§484.18(b) Standard: Periodic Review of Plan of Care

G163 The total plan of care is reviewed by the attending physician and HHA personnel as often as the severity of the patient's condition requires, but at least once every 60 days or more frequently when there is a beneficiary elected transfer; a significant change in condition resulting in a change in the case-mix assignment; or a discharge and return to the same HHA during the 60-day episode.

Interpretive Guidelines §484.18(a)

Written HHA policies and procedures should specify that all clinical services are implemented only in accordance with a plan of care established by a physician's written orders. Policies should also specify if the HHA: • Accepts physician's orders on referral communicated verbally by an institution's discharge planner, nurse practitioner, physician's assistant, or other authorized staff member followed by written, signed and dated physician's orders, in order to begin HHA services as soon as possible. • Accepts signed physician certification and recertification of plans of care, as well as signed orders changing the plan of care, by telecommunication systems (fax”), which are filed in the clinical record.

[HDHRN]

Yes, absolutely. But as a poster above stated, I usually get a verbal from the MA or nurse that works in the office. And since we just finished cold and flu season I needed to verify if they got a flu shot or pneumonia shot. I have several cases that I am just the case manager and the LPN does the visits, so that's why that information is valuable to me.

[LadyT618, MSN, APRN, NP]

Oh yes, verbal orders can be received from an agent of the physician of course, not necessarily the actual physician. Just make sure it is within that agent's scope to accept and give orders on physician's behalf for your respective state. :)