Page 76 - Rehab Orientation Manual 4 04 19-updated_Neat

administrative reasons (for example: discipline not available to provide services in patient’s area,
concern for staff safety, agency closing, or patient has not had face-to-face visit with certifying MD).

Discipline is reducing the frequency or duration of visits outside of the original POC

A. POC states 3x/week for 6 weeks, you receive order from MD decrease to 2x/week for 6
weeks

B. POC states 3x/week for 6 weeks, you reach goals week 4 and MD agrees to discontinue
services week 4

Administrative reasons (must always be discussed with your manager who will guide
you and must have MD approval)

A. No face-to-face encounter and certification (Medicare/Medicaid/United Managed
Medicare only)

B. Staff not available in service area

C. Concern for staff safety

3. Notice of Medicare Non-Coverage (NOMNC): Used to inform the patient in advance that
we are no longer billing Medicare. This form must be issued at least 2 calendar days before
discharge date.

Traditional Medicare

A. Ending Medicare billing because Medicare criteria is no longer met (for example: patient
not homebound, care no longer skilled, etc.)

B. Medicare only discharging entire case from VNSNY

C. Dually eligible patients - consider if services are necessary and can be billed under secondary
insurance (remember to issue ABN)

Managed Medicare

A. Authorization ending/denied

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