Home Health & Hospice Week

Don’t rely on your patient’s say-so to start delivering services. So says HHH Medicare Administrative Contractor Palmetto GBA in a recently posted set of questions-and-answers from its July 16 Ask the Contractor Teleconference.

Question: A home health agency asked how to handle a situation where a beneficiary switched physicians and the agency couldn’t get in touch with the doc. The patient told the agency "my physician said continue whatever you are doing until you hear from him." After recertifying the patient and making three visits, the physician did not sign the paperwork and the agency was told to discharge the patient. Then another agency called the original provider asking for the patient’s discharge date. The patient told the original agency he did not want to switch, but then agreed to the change after conferring with the new physician. "How can we bill Medicare for the three visits when the primary care physician does not want to sign the order?" the agency asked.

Answer: "While verbal orders from the certifying physician are acceptable, these orders must be written, dated and signed before the claim is submitted for payment," Palmetto explains. "Nowhere in Medicare’s regulations is there allowance for verbal orders by beneficiaries as noted in this scenario. Since you did not have orders for these services, you cannot bill them to Medicare for payment."