485/poc

megan@almahealth.netmegan@almahealth.net
in Oasis General
This question pertains to anyone working in the state of PA. There is a debate within our office and this seems to be a silly question.

Does the 485/POC need to be returned and signed by MD within 7 days of start of care? From my view point there is no way that the 485 can be signed within 7 days of start of care due to the audit process. Nowhere in the state and federal regulations does it say that the POC needs to be signed and returned within 7 days. According to CMS it needs to returned prior to billing.

If anyone has some insight please respond

Thanks
Megan

Comments

  • Unknown
    edited April 2017
    That may be applicable to Medicaid POC's, as here in Arkansas, we have 14 days, Medicaid-only, not Medicare.
    Check your state CoP's.

    Nancy Wolverton RN,CCM
    QR Specialist, Central Office
    5800 West 10th St., Suite 300
    Little Rock, AR. 72205
    Ph# 501-280-4913
    Fax# 501-280-4385
    Nancy.Wolverton@arkansas.gov
  • loramayes@hotmail.comloramayes@hotmail.com
    edited April 2017
    Make sure your policy does not say the 7 day rule. That would not be smart. The plan of care must be signed and returned before you send your EOE. Make sure the codes from the Oasis, POC and Bill are consistent. The RAP is not considered a "bill" per Medicare billing practices.
  • megan@almahealth.netmegan@almahealth.net
    It is 7 days to get a verbal order back and if they are not back there needs to be clear documentation that attempts were made to get them returned. If they are not returned with signature within 30 days regardless it is out of compliance. Our question is regarding the 485. Do other agencies view the 485 as verbal orders?

    Thanks
    Megan
  • loramayes@hotmail.comloramayes@hotmail.com
    edited April 2017
    Yes in the indicator where the RN signs, it sates "Nurse signature and date of verbal SOC/recert order". You should look at changing that policy. The orders will need to be back signed before the end of the episode. Since the regulation states that, you should give yourself that much time. The reality is you can get a deficiency for not following your own strict policy when you have more time. The orders management department could continue to strive for 7 days but I would never write that in a policy, even the 30 days. Always give yourself the same amount of time that the regulation allows. Hope this helps.
    Lora
  • loramayes@hotmail.comloramayes@hotmail.com
    edited April 2017
    I find that hard to believe
  • megan@almahealth.netmegan@almahealth.net
    Could you share your process for auditing the OASIS and creating the 485?

    Thanks
    Megan
  • loramayes@hotmail.comloramayes@hotmail.com
    edited April 2017
    We use Kinnser software. The Oasis generates the POC, the codes and treatment transfer over.
  • megan@almahealth.netmegan@almahealth.net
    Where is this in the CoPs?
  • Unknown
    edited April 2017
    My bad.
    The CoP's are Federal.
    The State Regs and the Medicaid Regs are where you should find the time-line info.
    My understanding is that if the two differ, then you must abide by the more stringent one.

    Nancy Wolverton RN,CCM
    QR Specialist, Central Office
    5800 West 10th St., Suite 300
    Little Rock, AR. 72205
    Ph# 501-280-4913
    Fax# 501-280-4385
    Nancy.Wolverton@arkansas.gov
  • Barbmacrn@gmail.comBarbmacrn@gmail.com
    edited April 2017
    Medicare billing manual states all orders must be received, signed and dated, before the final claim is submitted. State regs might be stricter. Maine licensing requires orders to be back and signed by day 30. Barb
  • loramayes@hotmail.comloramayes@hotmail.com
    edited April 2017
    Was it because of your policy? That cant be a state rule is it?
    Lora
  • Barbmacrn@gmail.comBarbmacrn@gmail.com
    edited April 2017
    Check your state regs. 7 days does not seem practical. If your agency policy is stricter than state reg, you will be held to that standard.

    Barbie
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