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January 15, 2019

Urgent Information for Home Health Providers: Advanced Directives

The Home Health Conditions of Participation 42 CFR 484.60 state the Plan of Care (POC) must include "Information related to any advanced directives." If a Medicare beneficiary has advanced directives, a home health agency is advised to indicate this on the POC, which signifies that the specific directives from the beneficiary have been obtained and documented in your records.

What providers need to know:

  • It is not necessary for home health providers to rebill or adjust previous claims submitted without the advanced directives on the POC.
  • CGS has not received direction from the Centers for Medicare & Medicaid Services (CMS) to begin reviewing for this information on the POC. However, CGS is seeking clarification concerning this matter with CMS.
  • Providers are encouraged to appeal these types of denials from the Comprehensive Error Rate Testing (CERT) program/contractor.
  • The POC is required prior to submitting the claim for payment, so submitting an addendum to the POC to add missing requirements after a claim was submitted would not be acceptable.


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