Page 59 - Clinical Managers Orientation Binder
P. 59
6/28/2019
Regulations:
Admission Medicare Coverage Criteria
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Regulations: During Care Delivery
1. Plan of care must be developed in collaboration with MD responsible for
signing the POC. All other MD’s involved in the POC are required to be
notified of the POC and any changes
2. Medicare requires Face to Face Encounter (90-30 rule)
*(As of July 13, 2017, Medicaid also requires a Face to Face Encounter)
3. Coordination of care with all MDs involved in POC must be documented
4. Claims must be billed in accordance with the law
5. Billing of home health aide services depends on documented supervision
every 14 days (HHA documentation is more closely monitored with new
COPs: skin changes & HHA POC matching duty sheets)
(42 CFR 484.14, 484.18, 484.36 & 42 CFR 409.42, 409.43,409.45; 42 CFR 424.22, 10 NYCRR 763.6 & 763.7; VNSNY P&P)
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