Home Health & Hospice

Clarification Orders Are Not Valid

Homecare Insider, June 21, 2010

There are many practices that can present risk when an agency comes under increased scrutiny.  It is the everyday actions that people do without thinking that will likely create the most trauma.  Consider this question from an agency administrative assistant:
Part of my job is to audit clinical records.  I find times when nurses made more visits than ordered.  Sometimes they assure me that they talked to the doctor and just forgot to write the order.  Other times, I don’t think they got the order.  I write clarification orders to the physician to cover these visits.  Is it acceptable just to note the change of frequency and the effective date, such as "Skilled nursing 1 wk 1, 2 wk 2, effective week of March 29"?  Or should I be including more information?

Ask an Expert could not answer this assistant’s question.  That’s because a clarification order to cover more visits or a forgotten order is an unacceptable and possibly fraudulent practice.

A clinician’s assurance that he or she got the order is not worth anything if there is no documentation in the record to support that.  If an agency does not have orders for visits before staff make them, no order written after the fact will suffice—no matter how it’s written.  The order becomes effective the date the physician signs it.

There is a second disturbing thing about this process.  This assistant is writing orders to match the care provided without any contact with the physician—in essence, prescribing for the patient.  Only a licensed physician can issue orders.

This agency faces denial of the visits made without proper authorization.  A surveyor may all take issue with these visits.  If this practice is widespread, the agency can find itself under intensive scrutiny.

Remember, if there is no documentation to support the physician’s prior authorization for care and services, there is no action an agency can take to cover those visits.  The agency must take action to get care back on track going forward.

Beacon Health’s Agency Reference Set provides the guidance an agency needs to ensure compliance with federal certification and coverage criteria.  To discover how these manuals can help your agency, click on — http://www.beaconhealth.org/cgi-bin/ccp51/cp-app.cgi?pg=prod&ref=pkBARS2.