Medication orders

kclarkrn86 · Aug 23, 2012

I think it depends on your state I only know that RN and LPN can.

kaliRN · Aug 24, 2012

Home Health agencies who are Medicare/Medicaid certified are regulated by the Centers for Medicare/Medicaid Services. Here is an excerpt regarding verbal orders from the Medicare Benefit Policy Manual, as well as a link to the full .pdf document. Note that federal, state, and agency guidelines are all used to regulate the implementation of verbal orders.

Verbal Orders — Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 30.2.5)

"30.2.5 - Use of Oral (Verbal) Orders

(Rev. 1, 10-01-03)

A3-3117.2.E, HHA-204-2.E

When services are furnished based on a physician's oral order, the orders may be accepted and put in writing by personnel authorized to do so by applicable State and Federal laws and regulations as well as by the HHA's internal policies. The orders must be signed and dated with the date of receipt by the registered nurse or qualified therapist (i.e., physical therapist, speech-language pathologist, occupational therapist, or medical social worker) responsible for furnishing or supervising the ordered services. The orders may be signed by the supervising registered nurse or qualified therapist after the services have been rendered, as long as HHA personnel who receive the oral orders notify that nurse or therapist before the service is rendered. Thus, the rendering of a service that is based on an oral order would not be delayed pending signature of the supervising nurse or therapist. Oral orders must be countersigned and dated by the physician before the HHA bills for the care in the same way as the plan of care.

Services which are provided from the beginning of the 60-day episode certification period based on a request for anticipated payment and before the physician signs the plan of care are considered to be provided under a plan of care established and approved by the physician where there is an oral order for the care prior to rendering the services which is documented in the medical record and where the services are included in a signed plan of care.

EXAMPLE 1:

The HHA acquires an oral order for I.V. medication administration for a patient to be performed on August 1. The HHA provides the I.V. medication administration August 1 and evaluates the patient's need for continued care. The physician signs the plan of care for the I.V. medication administration on August 15. The visit is covered since it is considered provided under a plan of care established and approved by the physician, and the HHA had acquired an oral order prior to the delivery of services.

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

EXAMPLE 2:

The patient is under a plan of care in which the physician orders I.V. medication administration every two weeks. The last day covered by the initial plan of care is July 31. The patient's next I.V. medication administration is scheduled for August 5 and the physician signs the plan of care for the new period on August 1. The I.V. medication administration on August 5 was provided under a plan of care established and approved by the physician. The episode begins on the 61 day regardless of the date of the first covered visit.

EXAMPLE 3:

The patient is under a plan of care in which the physician orders I.V. medication administration every two weeks. The last day covered by the plan of care is July 31. The patient's next I.V. medication administration is scheduled for August 5 and the physician does not sign the plan of care until August 6. The HHA acquires an oral order for the I.V. medication administration before the August 5 visit, and therefore the visit is considered to be provided under a plan of care established and approved by the physician. The episode begins on the 61 day regardless of the date of the first covered visit.

Any increase in the frequency of services or addition of new services during a certification period must be authorized by a physician by way of a written or oral order prior to the provision of the increased or additional services."

In our agency, all verbal orders, including those for therapy services are signed by an RN case manager (including those received by an LPN/LVN) before being submitted to the physician.

nannymcpheeRN · Aug 25, 2012

Kali, Thank you so much for this comprehensive response.

Alma 3323 · Dec 27, 2012

Mods, I recommend this be made a sticky because the link to the CMS is current and of great interest to HH nurses.