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Home Care / For Physicians / Patient-Driven Groupings Model / New Referral Requirements


New Referral Requirements

Please call our Intake Department at (585) 787-8338 with any questions.

Shorter Timetables for Physician Orders and Signature

  • Under Medicare, agencies must have all orders, including the Plan of Care, back in the office with your signature, date and time before any billing can be completed
  • Complete and sign orders in 5 business days necessary because claims are submitted every 30 days over the course of a 60-day plan of care

More Specific Primary Diagnoses

The following are key examples of primary diagnoses.

Rejected Referral: M25.561 - Pain in right knee

  • Accepted: Tight knee pain due to baker’s (Popliteal) cyst, patellar tendinitis OR
  • Accepted: Right knee derangement due to old meniscus tear

Rejected Referral: M62.81 - Muscle weakness (generalized)

  • Accepted: Sarcopenia OR
  • Accepted: Rhabdomyolysis OR
  • Accepted: Amyotrophic lateral sclerosis

Rejected Referral: Muscle wasting and atrophy (Need site and laterality)

Rejected Referral: R78.81 - Bacteremia

  • Accepted: Source infection that the bacteria is originating from has to be known. Example sources of infection:
    • Urinary tract infection
    • Endocarditis
    • Infection originating from a cutaneous wound such as an ulcer, traumatic wound, abscess
    • Osteomyelitis (Please specify site and chronicity)

Co-morbidities Drive the Level of Service Reimbursement

Co-morbidities will drive the level of service that Home Care is reimbursed in this new model. This is driven by the up-to-date problem list.