Physician Orders by FAX
in HHAs - INFORMATION
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Date: August 25, 2000 DSL-BQA-00-065
To: Home Health Agencies HHA 25
From: Otis Woods, Chief, Health Services Section
Via: Sue Schroeder, Director, Bureau of Quality Assurance
The Bureau of Quality Assurance (BQA) received the following clarification as
Electronic Regional Program Letter #2000-24 from the federal Health Care Financing
Administration, Division of Survey and Certification, Chicago
Regional Office. The enclosed letter [below] explains the position of the
federal Health Care Finance Administration on the faxing of signed physician orders.
Questions may be directed to Barbara Woodford, Nurse Consultant, at (715)
855-7310 (replaced by Marianne Missfeldt, (715) 836-4036), to
Jane Walters, Supervisor, at (608) 267-7389 (replaced by Jan Heimbruch, (608)
243-2086), or to Juan Flores, Supervisor, (608) 261-7824 (replaced
by Cremear Mims, (414) 227-4556).
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 Agency Directors
The following is recent Central Office policy guidance on the acceptance of physician
orders by fax machine in HHAs without following the fax order with the original order.
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 original
signature, if requested.
The Interpretive Guidelines for HHAs, Guidance to Surveyors, under 42 CFR 484.18(a),
states: "…Policies should also specify if the HHA: Accepts signed physician
certification and recertification of plans of care, as well as signed orders changing the
plan 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 supersedes 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. 42 CFR 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 physicians' 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.
/s/ Charles Bennett, Branch Manager, Survey and Certification
Program, Coordination and Improvement
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