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How can I refer my patient to Pristine Care Home Health Services, Inc?

Please fill out our “Quick Referral Form” and send back to us by fax or e-mail within 24 hours of referral date. By federal and state regulations, we need to perform an initial assessment of the patient’s needs for home health services and coordinate the initial assessment with you within 48 hours of referral date or physician-ordered start of care date.

How can I bill Medicare for referring my home health patients to you?

Please review the “How to Bill Medicare for all Home Health Eligible Claims” and the “Physicians Guide to Care Plan Oversight and Medicare Billing”. Use the “Care Plan Oversight Log for Medicare Billing” to monitor the care plans of your patients. If you need further assistance with the CPO, please CONTACT US and ask for our billing department.

Can you please guide me through the requirements that need to be met before I refer my patient for home health care under the Medicare Home Health Benefit?

Yes. The following are basic requirements:

  1. The patient is an eligible Medicare beneficiary and Medicare is the appropriate payer (once our referral coordinator receives the patient information including the insurance information, we will check the eligibility for your patient and notify you if Medicare will pay for the services);
  2. You (the certifying physician), or a qualified non-physician practitioner (NPP, such as nurse practitioner or physician assistant) working in conjunction with you, or a physician who cared for the patient in an acute or post-acute facility directly prior to being admitted to home health, must have a face-to-face encounter with your patient within 90 days before start of care or within 30 days after start of care. Only you can certify that such encounter has occurred.
  3. You must establish a care plan for your patient, periodically review the care plan and update your orders as deemed necessary, and supervise our clinicians in providing home health care according to the care plan
  4. You must certify that your patient is confined to his/her home, and requires intermittent, medically necessary, and reasonable home health services (skilled nursing and/or physical therapy, occupational therapy, and speech therapy).

For your guidance, please refer to “Medicare Home Health Benefit Policy Manual”.

Can I refer non-Medicare patients to you?

Yes. Please fill out the “Quick Referral Form” and send back to us by fax or e-mail. Our referral coordinator will get back to you within 24 hours and let you know if we can take the patient.