Use of Oral (Verbal) Orders

30.2.6 - Use of Oral (Verbal) Orders (Rev. 10438, Issued: 11-06-20, Effective: 03-01-20, Implementation: 01- 11-21) 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.