Dear People Who CONSTANTLY fax Health 485s

brandy1017, ASN, RN · Jul 19, 2012

What's a health 485?

caliotter3 · Jul 19, 2012

The 485 is a form that contains the home care patient's plan of care or plan of treatment, used in home health. It is signed by the doctor and is essentially, the doctor's orders for taking care of the patient. Formally, it is Form CMS-485, Dept. of Health and Human Services, Centers for Medicare and Medicaid Services, "Home Health Certification and Plan of Care".

caliotter3 · Jul 19, 2012

JZ, wish I could meet you. You admit to actually doing something with the info sent to you. Often I wonder if our stuff goes straight to a circular file! BTW, I would never resend anything to you unless you requested it.

allnurses Guide · Jul 19, 2012

Well, jz - welcome to the strange world of home health, where often it seems each person lives on their own desert island, and they have no idea what's happening on all the other islands in the island chain. It makes it very difficult to form a logical paper trail. It's not like you can call a meeting real quick for a heads up. Trying to get home health nurses all in one room at the same time is . . .interesting. All I can say is that it's better to have too many copies of a document than need one and find that it doesn't, to anyone's knowledge, exist at all. I feel your pain. :)

JZ_RN · Jul 19, 2012

The thing with it is, it may take me a week or two to get all the forms for a certain day or for a certain person or agency printed out and signed, yet, the home health agency sends me a copy daily begging me to get to it. I do actually have to do patient care, some days I don't get to do paperwork at all. I don't need people hounding me and filling up my message box about the same 485s all day haha.

allnurses Guide · Jul 19, 2012

Agencies really like to keep those current, as their livelihood depends on them not running afoul of the Medicare/Medicaid payer. If you are in the window for the current certification time, hounding you 24/7 shouldn't be necessary. My prior agency would send out a copy of the 485 without a doc's signature, and the one with the signature arrived around 5-7 days later.

Susan317 · Jul 19, 2012

Our policy is that if the 485 is not received back signed within a week it must be followed up on, and usually that means the MD's office has misplaced the original and asks us to refax a copy.

JZ_RN · Jul 21, 2012

I will literally get 2 or 3 copies of the same one in the same day or the same week. They send old ones we denied. They send ones with overlapping dates that make no sense. They just send send send and leave me with a stack of papers and no assistance in figuring out what one is correct. Our MD isn't certifying the forms when the dates overlap and 2 companies say they're serving the same patient. It won't be covered and we're not signing them. Anything that gets faxed to us gets electronically cataloged. It's almost as annoying trying to fish through the 14 copies of HH certification forms in the cart for the same person for multiple certification period. They send them for patients we haven't seen in like 2 years. Yeah right, we're not gonna sign that. I wish they'd do their homework before signing a patient on instead of annoying me with a million forms that won't even get signed most of the time anyways. I do a quick chart search of all the patient's forms. If there's multiple conflicting dates, meds aren't the same as ours, patient wasn't seen during the certification period, I just put a sticky note on it that they aren't certifiable and the doctor shreds them if they get printed. I don't have time to call every home health agency either. They need to determine if their patient meets requirements, I don't have time to be doing that 20 times a day. -sigh-

KelRN215, BSN, RN · Aug 3, 2012

I will literally get 2 or 3 copies of the same one in the same day or the same week. They send old ones we denied. They send ones with overlapping dates that make no sense. They just send send send and leave me with a stack of papers and no assistance in figuring out what one is correct. Our MD isn't certifying the forms when the dates overlap and 2 companies say they're serving the same patient. It won't be covered and we're not signing them. Anything that gets faxed to us gets electronically cataloged. It's almost as annoying trying to fish through the 14 copies of HH certification forms in the cart for the same person for multiple certification period. They send them for patients we haven't seen in like 2 years. Yeah right, we're not gonna sign that. I wish they'd do their homework before signing a patient on instead of annoying me with a million forms that won't even get signed most of the time anyways. I do a quick chart search of all the patient's forms. If there's multiple conflicting dates, meds aren't the same as ours, patient wasn't seen during the certification period, I just put a sticky note on it that they aren't certifiable and the doctor shreds them if they get printed. I don't have time to call every home health agency either. They need to determine if their patient meets requirements, I don't have time to be doing that 20 times a day. -sigh-

You know that it is very possible for multiple agencies to be servicing the same patient, right? So if your office automatically refuses to sign 485s if there's another one on file from another agency, that's probably creating more work for everyone. My agency does intermittent visits and private duty and a large number of the private duty patients are on service with more than one agency. Almost all of the intermittent patients have another agency as well- the agency that manages their supplies and that agency needs up-to-date orders as well.

JZ_RN · Aug 29, 2012

These are patients receiving a community health voucher for home health care. They are not insured patients and not paying out of pocket. We have an underserved population and usually they can only get payment for 1 agency or they are only allowed a certain amount of hours with a nurse or hha. That's why we only sign one or two if they have hha with one and nurse with another. It's not like a normal clinic, we have uninsured people and they try to get more than they are allowed.

bigtownRN · Sep 2, 2012

The other consideration is that the patient is in danger of losing their home health services if there is no valid MD order for the cert period, signed in time. In my experience as a Case Manager who creates the 485's, some docs take a month or more to get it back to us, and in the mean time we are not in compliance with Medicare/Medicaid rules so we have to stop giving home care, or risk citation.

As for the meds being incorrect, that is one reason we send our list, because we need an accurate list. Please send the accurate list back with the signed 485 and the corrections can be made.

Yes, it's true that some people have more than one agency. For example our company does not do PCA's anymore due to reimbursement issues. But we can provide HHA, homemaker and nursing. But if the PCA agency says they are doing RN supervisor visits periodically, it may look like the client is getting nursing from 2 different agencies. But they are not--it's just a supervisor visit which is all about supervision of the PCA, not a real nurse visit. I hope that makes sense.

I am glad you posted your frustrations, and are giving us the chance to respond. I think it helps everyone to have a better understanding of the other side's thoughts.