Resources for Physicians

Services provided by Panhandle Home Health, Inc. are medically directed. A physician must certify the need for home care for all services regardless of the pay source. The majority of the Agency’s patients are Medicare beneficiaries. Panhandle Home Health, Inc. is a Medicare certified home health agency. The Agency is dedicated to providing only medically necessary and appropriate services.

Physicians comply with Medicare criteria and are free of liability if they determine that the patient:

• Is essentially confined to home;
• Needs intermittent skilled nursing care, physical and/or speech therapy, or continues to need occupational therapy; (The patient can qualify to receive home health aide services or medical social services if the patient qualifies for one of the these services.)
• A plan of care is established, authorized, and periodically reviewed by the physician; and
• The services were furnished while the patient is under the care of the physician.

Physicians are at risk or liable only if they knowingly sign a patient’s certification that is false, misleading, does not comply with these criteria, or sign with reckless disregard for the truth.

WHAT ARE THE PHYSICIAN RESPONSIBILITIES?

• Know the patient’s history, condition, and need for Medicare services.
• Refer the patient to a Medicare-certified agency.
• Certify initially and, if the patient needs continuing care, on an ongoing basis that the patient is confined to the home, needs one or a combination of the above-mentioned services, and is under your care.
• Make the decisions about medical care and treatment and the patient’s services.
• Provide complete, appropriate orders for care and services that are reasonable and necessary.
• Sign the initial care plan, sign orders to change care, and sign renewal of orders every 60 days.
• Be available to agency staff when unexpected clinical problems arise.
• Ask the agency any questions about the patient or home care services.
• Provide the agency with a valid UPIN and license number.

HOW SHOULD A REFERRAL BE MADE FOR HOME CARE?

Physicians supervise home health services and can manage risks associated with supervision by designating the agency to provide services to their patients. Designations must be based upon quality of care only. However, patient choice overrides the physician’s designation. If the patient chooses a different agency despite the physician designation, the physician may supervise care provided by the agency of patient choice or refer the patient to a physician who will supervise the care at the agency chosen by the patient.

WHAT ARE THE HOME CARE AGENCY RESPONSIBILITIES?

• Verify that the patient is homebound and needs medically necessary and reasonable skilled nursing services or physical or speech therapy or continuing occupational therapy initially and on an ongoing basis.
• Discuss with the physician and make recommendations as appropriate about the patient’s medical care, treatment, and services.
• Provide appropriate services to the patient.
• Notify the physician about changes in the patient’s condition or plan.
• Participate with the physician in care planning decisions and coordination of services.
• Submit orders and plans of care to the physician for review and signature.
• Obtain the physician’s signature on verbal orders and plans of care before submitting claims.
• Ask the physician any question about the patient or home care services.
• Affirmative obligation to prevent and/or correct instances of fraud and abuse.

WHAT RESOURCES ARE AVAILABLE TO PHYSICIANS ABOUT HOME CARE?

• Medicare
• American Academy of Home Care Physicians (410) 676-7966
• National Association for Home Care (202) 547-7424
• American Academy of Hospice and Palliative Medicine (703) 787-7718

WHAT IS THE MEDICARE HOMEBOUND DEFINITION?

The physician must certify in all cases that the patient is confined to his/her home. An individual does not have to be bedridden to be considered as confined to the home. However, the condition of the patient should be such that there exists a normal inability to leave home and, consequently, leaving home would require a considerable and taxing effort.

Any absence of an individual from the home attributable to the need to receive health care treatment, including regular absences for the purpose of participating in therapeutic, psychosocial, or medical treatment in an adult day care program that is licensed or certified by a State, or accredited, to furnish adult day care services in the State shall not disqualify an individual from being considered to be confined to the home. Any other absences of an individual from the home shall not so disqualify an individual if the absence is of infrequent or relatively short duration. For purposes of the preceding sentence, any absence for the purpose of attending a religious services should be deemed to be an absence of infrequent or short duration. Occasional absences from the home for non-medical purposes, e.g., an occasional trip to the barber, a walk around the block, a drive, attendance at a family reunion, funeral, graduation, or other infrequent or unique event would not necessitate a finding that the patient is not homebound if the absences are undertaken on an infrequent basis or are of relatively short duration and do not indicate that the patient has the capacity to obtain the health care provided outside rather than inside the home.

Generally speaking, a patient will be considered to be homebound if he/she has a condition due to an illness or injury that restricts his/her ability to leave his/her place of residence except with the aid of supportive devices such as crutches, canes, wheelchairs, and walkers, the use of special transportation, or the assistance of another person, or if leaving home is medically contraindicated.