Physician or Allowed Practitioner Orders, Plan of Care and Certification
All services provided under the Medicare home health benefit must be ordered by a physician or allowed practitioner. Three basic requirements for ordering services are:
- The physician or allowed practitioner must be enrolled in Medicare;
- The ordering National Provider Identifier (NPI) must be for an individual physician (not an organizational NPI); and
- The physician or allowed practitioner must be of a specialty type that is eligible to order and refer.
Consult the following topics for more specific information on the physician's or allowed practitioner's involvement and the technical components of orders.
- Under a Physician's or Allowed Practitioner's Care
- Physician Requirements Resources
- Physician or Allowed Practitioner Certification and Recertification of Patient Eligibility for Medicare Home Health Services – Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7, §30.5)
- Content of the Physician or Allowed Practitioner Certification – Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7, §30.5.1)
- MM11104, Manual Updates Related to Home Health Certification and Recertification Policy Changes
- Home Health Face-to-Face (FTF) Encounter
- Definition of Allowed Practitioner – Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §30.2.1)
- Content of the Plan of Care – Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §30.2.2)
- Specificity of Orders – Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §30.2.3)
- Use of Ranges in Physicians Orders
- PRN Orders
- Who May Sign the Certification or Recertification – Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §30.5.3)
- Medicare Program Integrity Manual (CMS Pub. 100-08, Ch 3 §3.3.2.4)
- Signature Guidelines for Medical Reviewquick resource tool
- Medical Review Signature and Attestation Guidelines CGS web page
- Facsimile Signatures
- Alternative Signatures
- Verbal Orders – Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §30.2.6)
- Timeliness of Signature – Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §30.2.5)
Updated: 12.20.21