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Home Health Physical Therapy

Update:  The Louisiana DHH clarified on Friday afternoon that even though they expect orders and goals to be included on the care plan, it is recognized that this is not always possible.  In these instances, a separate verbal order containing all of the physical therapy goals and orders is satisfactory.  We apologize for any confusion.  Please feel free to comment below or email us at if you have any questions.

It is common for agencies to order a Physical Therapy evaluation on home health admission and wait until the paperwork has been submitted to the office to write orders for frequency, treatment modalities and goals.  These orders have traditionally been sent to the physician as a separate verbal order.  Well, most of the time:)

During a recent client survey, a state surveyor informed us that CMS now expects the orders for frequency, modalities and goals to be on the 485.  Because this was contrary to the advice we have traditionally offered to our clients, we called the Louisiana Department of Health and Hospitals.  Louisiana DHH also informed us that CMS expected all orders and goals for physical therapy to be included on the 485 and failure to do so will appear as thought the agency simply didn’t complete the care plan.

So there you have it.  Managing Physical Therapy has always been a challenge in Home Health.  We would like to hear your views on these changes.  Is this how your agency already does therapy?  Will changing to this process improve or impede coordination of care in your agency?  Or is this change so insignificant that it can be integrated into your current process without much trouble.

To leave a comment, click on the link below.  To resond privately, email us at

3 Comments Post a comment

  1. We usually have nursing open all our cases. Physical Therapy is usually out that day or the next day. We wait until the physical therapist completes their evaluation and orders before completing the 485, so we have the PT orders and OT orders on the initial plan of care. We were surveyed last in December of 2007 by Joint Commission and they had no problems with our 485.

    March 12, 2009

    • I think what you are doing is also meeting the CMS referral guidelines. The problems arise when PT/OT is ordered on referral and they do not get out to admit the patient within the allotted time frame as measured from the referral. Regardless of what I think, I never argue with a good survey! Congratulations. But also note that the date of your survey occurred before our surveyors started scrutinizing this area of therapy referrals. It may be an idea to check with your state agency or association to make sure the focus won’t be changed on your next survey!

      March 12, 2009

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