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Plan of Care Supports Documentation of Homebound Status

Homecare Insider, February 15, 2010

The plan of care, formerly known as the CMS-485, is a very important document.  However, it cannot be the only document that supports Medicare service delivery.  Consider this question.
Should my staff document homebound status on the plan of care?  Or is it sufficient to check functional limitations, activities permitted, and diagnoses?  Medicare requires the physician to certify that the patient is confined to home.  We have been documenting a complete homebound statement on the plan for 15 years but I cannot find the rationale for this.

The rules are not specific as to when, what, and how to document homebound status.  Clinicians must utilize appropriate parts of the clinical record to support the determination.  Beacon Health developed the four components of homebound status as a way to guide documentation.  These components are:

  • The functional limitation that restricts mobility
  • The medical or physical reason for the limitation
  • The impact of the limitation on the patient’s activity
  • Absences from the home (number, reason, length, and assistance required and/or taxing effort) showing that the patient is indeed confined to home.

It is not necessary or possible to document all four components on the plan of care.  However, selected locators on the plan can support the homebound determination.  

  • Functional limitation is the broad description of why the patient is limited in his or her ability to leave home.  Limitations in Locator 18A on the plan of care that support homebound status include ambulation, paralysis, dyspnea, endurance, amputation, contracture, and legally blind.
  • Activities permitted in Locator 18B identify activity limitations or assistive devices, such as transfer bed/chair, partial weight bearing, or walker.
  • A diagnosis explaining or supporting the patient’s functional limitation connects homebound status to the illness or injury, showing that the patient is confined to home because of a medical issue.  Examples include congestive heart failure to support limited endurance, hemiplegia to explain a limitation in ambulation, and emphysema to support dyspnea.  

After reviewing the patient’s condition and plan, the physician’s signature is the certification of homebound status.

Need a refresher course on determining and documenting homebound status?  You’ll get that in Homebound Status:  The Core of Medicare Coverage.  Learn more about this DVD program at — http://www.beaconhealth.org/cgi-bin/ccp51/cp-app.cgi?pg=prod&ref=22-410-00.

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