CMS Pub. 100-02, ch. 7, § 30.2.6

When services are furnished based on a physician or allowed practitioner’s oral order, the

orders may be accepted and put in writing by personnel authorized to do so by applicable

State and Federal laws and regulations as well as by the HHA's internal policies. The

orders must be signed and dated with the date of receipt by the registered nurse or

qualified therapist (i.e., physical therapist, speech-language pathologist, occupational

therapist, or medical social worker) responsible for furnishing or supervising the ordered

services. The orders may be signed by the supervising registered nurse or qualified

therapist after the services have been rendered, as long as HHA personnel who receive

the oral orders notify that nurse or therapist before the service is rendered. Thus, the

rendering of a service that is based on an oral order would not be delayed pending

signature of the supervising nurse or therapist. Oral orders must be countersigned and

dated by the physician or allowed practitioner before the HHA bills for the care in the

same way as the plan of care.

Services which are provided from the beginning of the 60-day certification period based

on a request for anticipated payment and before the physician or allowed practitioner

signs the plan of care are considered to be provided under a plan of care established and

approved by the physician or allowed practitioner where there is an oral order for the care

prior to rendering the services which is documented in the medical record and where the

services are included in a signed plan of care.

Services that are provided in the subsequent 60-day certification period are considered

provided under the plan of care of the subsequent 60-day episode where there is an oral

order before the services provided in the subsequent period are furnished and the order is

reflected in the medical record. However, services that are provided after the expiration

of the plan of care, but before the acquisition of an oral order or a signed plan of care are

not considered provided under a plan of care.

EXAMPLE 1:

The HHA acquires an oral order for I.V. medication administration for a patient to be

performed on August 1. The HHA provides the I.V. medication administration August 1

and evaluates the patient's need for continued care. The physician or allowed practitioner

signs the plan of care for the I.V. medication administration on August 15. The visit is

covered since it is considered provided under a plan of care established and approved by

the physician or allowed practitioner, and the HHA had acquired an oral order prior to the

delivery of services.

EXAMPLE 2:

The patient is under a plan of care in which the physician or allowed practitioner orders

I.V. medication administration every 2 weeks. The last day covered by the initial plan of

care is July 31. The patient's next I.V. medication administration is scheduled for August

5 and the physician or allowed practitioner signs the plan of care for the new period on

August 1. The I.V. medication administration on August 5 was provided under a plan of

care established and approved by the physician or allowed practitioner.

EXAMPLE 3:

The patient is under a plan of care in which the physician or allowed practitioner orders

I.V. medication administration every 2 weeks. The last day covered by the plan of care is

July 31. The patient's next I.V. medication administration is scheduled for August 5 and

the physician or allowed practitioner does not sign the plan of care until August 6. The

HHA acquires an oral order for the I.V. medication administration before the August 5

visit, and therefore the visit is considered to be provided under a plan of care established

and approved by the physician or allowed practitioner.

Any increase in the frequency of services or addition of new services during a 60-day

certification must be authorized by a physician or allowed practitioner by way of a

written or oral order prior to the provision of the increased or additional services.