Information Bulletin 00-27
Physician Orders By Fax
The purpose of this information bulletin is to share information received from Electronic Regional Program Letter #2000-24, from Health Care Financing Administration (HCFA) regarding guidance on the acceptance of physician orders by fax machine in HHAs without following the fax order with the original order.
If you have any questions regarding this Information Bulletin, please contact in writing:
Minnesota Department of Health
Compliance Monitoring Division
Licensing and Certification Program
85 East Seventh Place, Suite 300
PO Box 64900
St. Paul, Minnesota 55164-0900
Telephone: (651) 201-4101
Health Care Financing Administration
Chicago Regional Office, Midwest Consortium
Electronic Regional Program Letter #2000-24
DATE: August 17, 2000
FROM: HCFA, Chicago Regional Office, Division of Survey and Certification
SUBJECT: Physician Orders by FAX in HHAs - INFORMATION
TO: State Survey Directors
The following is recent Central office policy guidance on the acceptance of physician in HHAs without following the fax order with the original code.
The Medicare Home Health Agency Manual, Transmittal 277, dated April 1996, states: "The plan of care or oral order may be transmitted by facsimile machine. The HHA is not required to have the original signature on file. However, the HHA is responsible for obtaining original signatures if an issue surfaces that would require verification of an original signature." It further states: "While the regulations specify that documents must be signed, they do not prohibit the transmission of the plan of care or oral order via facsimile machine. You are not required to have the original signature on file. However, you are responsible for obtaining original signatures if an issue surfaces that would require verification of an original signature." The HHA should be able to provide original orders within a reasonable timeframe upon the surveyor's request. The Medicare Reference Guide for Home Health Agencies, dated August, 1999, states: "We will accept a facsimile (FAX) physician signature on the HCFA-485 and on additional order forms. You must be able to obtain a copy of the physician's order with the Interpretive Guidelines for HHAs, Guidance to Surveyors, under 42 CFR 484.18(a), which states "...Policies should also specify if the HHA: Accepts signed physician certification and recertification of plans of care, by telecommunication systems ("fax"), which are filed in the clinical record."
There were two previous memoranda on this subject dated February 13, 1992, and May 3, 1993. The information provided in the May 1993 memorandum supercedes that of the February 1992 memorandum. Current policy, as stated in the May 1993 memorandum and in the above citations, permits the use of fax transmission to obtain the physician's orders for the patient.
Additionally, CO provided clarification of a State agency's requirement that mandated a physician's signature for verbal orders in the clinical record within fourteen (14) days. HCFA's policy has always been to defer to the state's policy if it is more stringent than the Federal requirement. 42CFR 484.12(a) states: "The HHA and its staff must operate and furnish services in compliance with all applicable Federal, State, and local laws and regulations." Therefore, we would expect the HHA to comply with the State's policy of "All physician's verbal orders for care shall be signed and incorporated into the clinical record within fourteen (14) days."
If you have any questions about this policy clarification, please contact your Branch Manager or the Principal Program Representative assigned to your state.
Survey and Certification Program
Coordination and Improvement