Home Health Referral

The beginning of every home health services admission or resumption of care starts with a referral. It seems so simple. However, just what is required for a referral to be valid?  Home health agencies continue to struggle with this and are negatively affected by the process measure, timely initiation of care, when an invalid referral date is documented.  This issue is demystified in a CMS OASIS Q&A—Category 4b, Q23.11.6 regarding M0104—Date of Referral.  The aspects required for a valid referral are:

• The agency has received adequate information about a patient–name, address/contact information, and diagnosis and/or general home care needs; and
• The agency has ensured the referring physician, or another physician/allowed practitioner will provide the plan of care and ongoing orders.

A referring physician/allowed practitioner who has no intention of providing the plan and care and following the patient has not made a valid referral to the agency (for the purposes of completion of M0104).  At this point, the agency must contact an alternate or attending physician/allowed practitioner to determine if he/she will agree to establish the plan of care and follow the patient.  When this is confirmed, the agency has a valid referral date to enter on M0104 and needs to initiate care within two days unless a physician-ordered SOC/ROC is coded.