The Plan of Care (Form 485) must be signed and dated by a physician before the claim for each episode for services is submitted for the final percentage payment.
Initial Percentage Payment Reminder
If a physician signed Plan of Care (Form 485) is not available at the beginning of the episode, the HHA may submit a RAP for the initial percentage payment based on a physician’s verbal orders OR a referral prescribing detailed orders for the services to be rendered that is signed and dated by the physician. A billable visit must be rendered prior to the submission of a RAP.
DME as covered service by a Home Health Agency
DME must be differentiated from routine and non-routine medical supplies which are bundled to the agency and included in the base rate payment. Durable Medical Equipment (DME) is paid separately from the PPS bundled rate and is excluded from consolidated billing requirements governing PPS. The determining factor is the medical classification of the supply, not the diagnosis of the patient.
