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CMS 485: Getting Professional Health Care at Home

Using the CMS 485 Form for Home Health Care Certification and Plan of Care

It is not uncommon to ask for medical treatment to be given in a patient’s home rather than in a healthcare institution. To accomplish this, a patient’s attending physician has to complete Home Health Care Certification and Plan of Care, also known as the CMS 485 Form.

Who needs a CMS Form 485?

The CMS Form 485 has been designed by the US Department of Health and Human Services, Centers for Medicare & Medicaid Services. By filling out Form 485, the physician prescribes relevant health care services covered by Medicare home health benefits. Still, certain requirements must be met with regards to a physician’s eligibility to order home care. The physician must
• be a Medicare registrant,
• have an eligible specialty,
• and have an individual National Provider Identifier (NPI number).

What is the Home Health Certification and Plan of Care for?

The form CMS-485 is used by the HHA – Home Health Care Agency to serve as a plan of care and certification or recertification in case the physician assumes oversight of patient care.
The completed form provides all the information required to deliver relevant treatment and medical care to the patient, outside of a specialized institution.

Is Form CMS-485 accompanied by other forms?

To provide a patient with home health care, an authorizing physician is obligated to provide a document confirming a face-to-face encounter. There is also a time restriction requiring that the face to the face encounter must take place not earlier than 90 days before the claim or within 30 days after home health care starts.

When is the Home Health Care Certification and Plan of Care due?

The CMS 485 form does not have a specific due date.  The homebound patient can start receiving home health care services right after the relevant documentation has been submitted by a physician to a home health care agency (HHA). However, the CMS-485 must be duly filled out taking into consideration the time frame for submitting the face-to-face encounter statement. Also, the effective date of Home Health Care Certification and Plan of Care form cannot exceed 60 days. If it is necessary to prolong home care, a new CMS-485 form must be completed.

How do I fill out Form CMS 485?

As stated above, the patient’s attending physician (or sometimes a nurse) is to complete the CMS 485 form.

The data that must be indicated comprises the following:
• Claim number
• Care period
• Patient’s identification (name, address, date of birth, sex )
• Health care provider’s identification
• Patient’s ICD details
• Allergies
• Functional limitations
• Permitted activities
• Prognosis and goals, etc.

Finally, it is mandatory that the attending physician should certify the CMS 485 form by providing a signature and dating the document.

Where do I send  Home Health Certification and Plan of Care?

The completed form should be directed to the home health care agency (HHA) that will be responsible for taking care of the patient. A copy of the form should be kept in the patient medical records, and the patient should also retain a copy.