* to perform clean dressing change using XYZ dressing on patient's left heel.Īs noted above, the content of the discipline-specific orders must include Medicare-covered skilled services in order for Medicare to pay for the services. * for teaching the patient's wife clean dressing change using XYZ dressing on Stage 3 decubitus ulcer on patient's left heel, and * or skilled observation and assessment of the Stage 3 decubitus ulcer on patient's left heel * for skilled observation and assessment of the patient's condition including vital signs, blood sugar, and signs and symptoms of hyperglycemia For example, after the frequency detailed above, the order might read: Particular techniques, medical supplies, durable medical equipment, or medications, when required, should be specified in the orders. Treatment codes are available in the Medicare Home Health Agency Manual ( DHHS, 2003) and can be used with the accompanying description where applicable.Ĭertain codes require additional descriptive detail. The physician's orders in the Medicare POC should also specify the exact treatments or services each discipline is expected to provide according to the required frequency. The frequency of each discipline's visits should be specified in similar detail. If the physician intends for the nurse to then reduce the frequency to two times per week for an additional 3 weeks, the frequency would be written as SN x 3/wk x 3 wk 2/wk x 3 wk. * the duration of the service delivery ( DHHS, 2003).įor example, if the physician wants a nurse to visit a patient three times per week for 3 weeks to provide skilled services, the frequency would be represented in the order as SN x 3/wk x 3 wk. * the frequency of the services to be provided, and * the discipline responsible for providing the services, Verbal orders must meet Medicare requirements, as well. Changes that are required in the original POC are typically secured by writing verbal orders based on a telephone conversation with the attending physician. As such, they must be specific and detailed, and should include Medicare-covered services. The physician's orders are truly the heart of the Medicare Plan of Care (POC). ![]() Therefore, it is important that home care clinicians understand regulatory requirements that dictate the format and authentication of physician's orders in the home care environment.Īs was noted in a previous Signposts for Compliance column, the physician's orders provide the road map that tells clinicians how to get a home care patient from admission to discharge ( Zuber, 2003). As a result physician's orders are required for these agencies' non-Medicare patients as well.Įven agencies that don't participate in the Medicare program generally operate in states where professional licensure laws require that skilled services be provided only on the order of a physician, podiatrist, advance practice nurse, or physician's assistant. Further, the Social Security Act requires that home health providers who participate in the Medicare program must treat all patients according to the same standards (U.S. The Medicare program, which currently funds over one-half of the skilled home health services provided in the United States, requires all skilled services to be authorized by a physician (defined as a doctor of medicine, osteopathy, or podiatry) ( DHHS, 2000). Facing Ethical Challenges with Strength and CompassionĪ physician's order is almost always required for home health services to be provided.Establishing Yourself as a Professional and Developing Leadership Skills.Ensuring Patient & Family Centered Care. ![]() Developing Critical Thinking Skills and Fostering Clinical Judgement.Alteplase Injection for Acute Ischemic Events.Affirming Care for Patients who are LGBTQ+.Lippincott Clinical Conferences On Demand.Continuing Education Bundle for Nurse Educators. ![]() Lippincott NursingCenter’s Critical Care Insider.Lippincott NursingCenter’s Career Advisor.Academic/Practice Innovation: An Interview with Dr.Becoming Great in Healthcare: Webinar Highlights.People Connections and Building Relationships: An Interview with Cathleen Wheatley.Teamwork is the Bedrock of a High Trust Culture.Connecting as an Organization Post-COVID.Supporting Staff Through Patient-Centered Innovation.
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