Page 60 - Clinical Managers Orientation Binder

6/28/2019

Regulations: Plan of Care

1. Adherence to MD Plan of Care
a. Collaboration with ALL MDs (Initial SOC-Changes-Recerts-
Discharge)
b. Obtain Verbal Order
c. Document in clinical notes and coordination notes

d. Create Modifier with documenting orders

2. Patient scheduling - New System
a. Must follow plan of care
b. Missed Visits reported to Patient/MD

17

Regulations: Discharge

1. Discharge plan shall be initiated prior to agency discharge to assure a timely,
safe and appropriate transition for the patient
2. Discharge must be appropriate …
3. Services shall not be diminished or discontinued solely because of the change
in the patient's source of payment or the patient's inability to pay for care
4. Issue Medicare notices as needed: NOMNC
5. Discharge OASIS must be completed within 2 calendar days of
discharge/transfer/date of death. This must be completed timely due to the
CoP requiring discharge summary to be sent to PCP or facility within 5 days of
discharge.

6. Appeal for Medicare cases (Livanta is QIO)
(42 CFR 411.404,42 CFR 405.1200, 42 CFR 484.55; 10 NYCRR 763.5)

9