485 whoo's

[AmPmRnoncall]

To all you experienced home care nurses. We just started something new. Our 485's are entered into our data system by a data processer, then reviewed by one of our RN coordinators for accuracy, then signed by the coordinator. As an example:: J.Smith RN for L. Jones RN.... IS THIS LEGAL. I DON'T EVEN GET A CHANCE TO REVIEW THE 485 BEFORE IT IS SENT TO THE PHYSICIAN. I have 10+ years of home care experience and have never done this before. It is a new policy that we just started. And I am now noticing many errors on my filed 485's that the physican has already signed.:gandalf:

[medicrnohio, RN]

We do not sign our own 485's. In fact I have noticed that the QA nurses who review our 485 load forms add and remove things as they desire. Then some nurse in the corporate office signs our 485's.

[NRSKarenRN, BSN, RN]

from: cahaba medicare

coverage guidelines

80.40 [color=#231f20]verbal/oral orders

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medicare benefit policy manual [color=#231f20](cms pub. 100-2, ch.7 30.2.5)

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a physician's verbal order to provide services may be accepted and put in writing by personnel authorized to do so by state and federal laws and regulations, as well as by the hha's internal policies. the orders must be

signed and dated by the physician, 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) whom the agency has designated responsible for furnishing or supervising the ordered services.

on occasion, a verbal order is received but not documented. in the absence of documentation of verbal orders, a notarized statement from the physician that he/she gave verbal orders before the services were provided is acceptable. the orders may be signed after the services have been provided as long as the hha personnel who received the verbal orders notifies the nurse or therapist before the service is provided. this allows the services, based on the verbal order, to be provided without delay pending the signature. please note that the notarized statement from the physician [color=#231f20]must [color=#231f20]also be signed and dated before the services are billed to medicare.

it is appropriate to use verbal orders for:

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- [color=#231f20]services provided from the beginning of the certification period and before the physician signs the plan

of care

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- [color=#231f20]services provided in the subsequent certification period (recertification) before the physician signs the

recertification plan of care

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- [color=#231f20]any change in the plan of care (e.g., change in the frequency of services or the addition of new

services) during a certification period

80.45 [color=#231f20]services provided before physician signs the certification plan of care

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medicare benefit policy manual [color=#231f20](cms pub. 100-2, ch.7 30.2)

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a physician's verbal order for services must be obtained before services are provided. this applies to services provided from the start-of care-date for the certification period until the physician signs the certification plan of

care. the verbal order must be documented in the medical record and the services included in a signed plan of care. the verbal order must include, at a minimum, the type of services to be provided, the discipline providing

the services, and the frequency at which the services will be provided.

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80.35 - 80.45