MEDICARE HOME HEALTH REFERRAL CHECKLIST

SKILLED NURSING visits are considered skilled/reimbursable by Medicare for:

OBSERVATION/ASSESSMENT	TEACHING/TRAINING	TRACHING/TRAINING
Including, but not limited to .. .	Including, but not limited to .. .	Including, but not limited to .. .
• Circulatory changes	Bowel/bladder training	Calcimar injections (with appropriate diagnosis & labs)
• Edema	Diabetic care	Cartheter changes
• Exacerbated diagnosis	Disease process	Anodyne treatments
• Fluctuating vital signs	Enteral/Parenteral feedings	IM/ SQ/ ID injections
• Initiation of medical gases	Injections	Insulin injections
• New diagnosis	Intermittent catheterization	IV infusions
• Post-hospital follow up evaluations	Medication regimen	NP/ Trach suctioning
	Ostomy care	Ostomy care
• Respiratory changes	Reportable signs & symptoms	Tube feeding
• Symptoms of drug toxicity	Specified procedures	Wound care
• Weight changes	Wound care

PHYSICAL THERAPY is comsidered skilled / reimbursable if the level of need requires intervention by a trained therapist when the patient has difficulty getting in/out or repositioning in bed, walking (inside or outside), going up or down steps, standing / sitting, or getting on/off toilet or bedside commode OR
Patient has:

• Contractures or pressure areas
• Decline in function related to stroke, pain, arthritis, amputation, etc.
• Equipment needs
• History of falls
• Limited ROM, decreased sensation or strength
• Poor safety awareness
• Shortness of breath with activity
• If you have pain due to poor circulation, try our Anodyne Therapy treatment in the comfort of your home!