Form CMS-485 Home Health Certification and Plan of Care

What Is CMS-485 Form Used For?

Although Home Health is known for a great number of documents, the CMS Home Health Certification form stands out, as it combines the orders of various medical disciplines into one form. The importance of this document explains its name as a "Mother Document." By filing this form, the doctor prescribes relevant health care services that are covered by Medicare home health benefits. This document governs the home charts and care provided by the nurses.

CMS-485 contains the patient and provider demographics and statistics, medication information, nursing orders, diagnosis and procedure codes, lists of supplies, nutritional requirements, allergy information, patient activities and limitations, ancillary care orders (e.g. OT, PT), goals and discharge plans, and, finally, a Penalty Statement for falsification, misrepresentation or concealment of essential information in the document.

CMS Home Health Certification requirements state that the patient must be evaluated. The nurses have to be supervised and orders rewritten at least every 60 days. All treatment and medications listed on the form become Doctors Orders once signed. All other documents in the home chart (i.e., Medication Administration Record) follow the orders documented on the CMS-485 Form (with the exception of interim orders written and signed after the date of the form). The form is used in cases when the doctor or nurse is unsure, or when verification of Rx/Tx's is required.

Health care providers must keep this form updated and accurate. Although it is edited by the nursing supervisor and endorsed by the physician every 60 days, the plan is usually adjusted during this period to match the current condition of the patient. Medications can be changed, diet, therapies, and activity can be started or stopped. When these interim alterations take place, the caregiver is responsible to verify the information and pass it on to the nursing supervisor. The changes must be justified and the form adjusted in a timely manner to be accurate in the next certification period. Verification can be done either through the phone, fax, or Verbal/Telephone (VO/TO) orders forms.

Timely and accurate communication is the professional caregivers' responsibility. CMS-485 and interim orders are checked on a consistent manner and timely communication is the cornerstone of excellent health care.

Form CMS-485 Instructions

The form should not take more than 15 minutes to fill out. Enter the patient's personal information in Sections 1 to 9. Enter their treatment information including medication, allergies, safety, and nutritional requirements in the following sections. Specify the amount, frequency, and duration of treatment in Section 21. Follow by Goals and Discharge plans in Section 22. The document requires the signature of the nurse and the patient's physician. All interim order copies must be kept with the form for reconciliation by all health caregivers.