Policy Manual sample

MDT Home Health Care Agency, Inc. PHYSICIAN LETTER OF MEDICAL NECESSITY (Optional, Requested as needed) POLICY To provide requesting reimbursement source with detailed correspondence, if requested, not required in all patients. PURPOSES 1. To outline the client’s needs for service(s) and the responsibilities, duties and tasks to be performed to support the client’s needs. 2. To provide detailed information in support of professional (RN, LPN) services. PROCEDURES 1.The Field Staff Supervisor will notify the Director of Nursing, Clinical Manager of Home Health Care Services regarding the request for a Physician Letter of Medical Necessity during the insurance investigation process. 2. The Director of Nursing, Clinical Manager of the Home Health Care, Nursing Supervisor or Registered Nurse Case Manager will telephone the attending physician, physician assistant, or advanced registered nurse practitioner, regarding the requested need for a Physician Letter of Medical Necessity. 3. The Director of Nursing, Clinical Manager of Home Health Care, Nursing Supervisor, or Registered Nurse Manager may offer to construct a Physician Letter of Medical Necessity for the attending physician to assist the timeliness of the letter. 4. The contents of the Physician Letter of Medical Necessity should include but are not limited to the following: a. Diagnosis (primary, secondary, diagnosis relating to services). b. Therapy Service(s). c. Importance for service at home versus hospital (if applicable). d. Estimated duration of therapy service. e. Client’s needs for service (nursing diagnosis). f. Responsibilities of agency personnel (detailed) g. Duties of Home Health Care Agency’s personnel (detailed). h. Tasks of Home Health Care Agency’s personnel (detailed). Supplies. j. Eternal calories per day per food supplement (if applicable). k. Explain reason(s) for excesses of one or more supplies beyond customary and reasonable quality (i.e. gauze, tape, gloves). Home Health Agency Policies A-22