Page 72 - Business Development Orientation Binder

Applies to: VNSNY Certified Home Health Agency
Service: VNSNY Certified Home Health Agency
Procedure Section: Provider Service Administration
Number: CP.181
Page 2 of 8

i. For referrals received via E-Platform , HCC visits patient in the hospitals and
prepares them for discharge and emails information to Branch Intake
Coordinator for entry
ii. For referrals received through Regional Intake, the HCC assesses the
patient at the bedside and formulates a discharge plan. This is to be
communicated through BD Onsite assessment note. HCC is responsible for
attaching clinical information, and obtaining F2F for Medicare beneficiaries.

5. After all pending referral entries are completed, Revenue Cycle Department
(RCD) will verify insurance and will obtain pending authorization before the case is
released for review by the Clinical Field Manager (CFM) unless directed otherwise
by the senior level management. RCD will confirm co-pay and deductibles. This
information is documented by RCD in the insurance verification coordination note.

6. After Payer verification is completed, a referral must be further reviewed and
approved by the Clinical Field Manager (CFM) to determine if there is a reasonable
expectation that the patient can be cared for safely at home and to confirm that
sufficient plans are in place to enable its staff to provide necessary care and
treatments in a manner that protects and promotes the patient's health and safety
and does not jeopardize the safety of personnel.

7. Additional patient/family information must be available to the extent possible to
make this determination. Required information may be anything relevant to the
safety and appropriateness of the home care plan and may include but not be
limited to: social situation; clinical information, i.e., diagnoses, medications, any
surgeries/procedures, services and/or treatments being requested; functional
information including mental status; Face to Face Certification for Medicare and
Medicaid Beneficiaries.

Referrals marked as “Do Not Re-Admit” indicate a previously known patient that
was discharged for one of the following reasons: an unsafe environment; non-
compliant with the plan of care; illegal activity or violence in the home; or for a fiscal
related issue. Prior to readmission of such patient, Branch Director must be
consulted to evaluate if the patient now meets home care criteria. If the patient is
accepted for admission, patient is marked as “OK to Admit’ by the Branch Director.

Responsibility: Quality Management Services-Homecare
Procedure date:
Revised: 06/2015, 12/2016, 12/2017, 12/2018
Approval: Senior Vice President, Patient Care Service