M0104: CMS OASIS Q&As

If the start of care is delayed due to the patient’s condition or physician/allowed practitioner request and no date was specified as the start of care date, then the date the agency received updated/revised referral information for home care services to begin would be considered the date of referral. In your scenario, June 2 is the correct response for M0104 Date of Referral.

M0104 - Date of Referral, is the date stamped by your fax machine indicating when the referral was received.

In order to be eligible for the Medicare Home Health benefit, a patient must be “Under the care of a physician”. A valid referral is considered to have been received when the agency has received adequate information about a patient (name, address/contact info, and diagnosis and/or general home care needs) to initiate patient assessment and the agency has ensured that the referring physician, or another physician or allowed practitioner will provide the plan of care and ongoing orders. In cases where the referring physician is not going to provide orders and follow the patient, this is not a valid "referral" for M0104 – Date of Referral. In the example of a hospitalist who will not be providing an ongoing plan of care for the patient, the HHA must contact an alternate, or attending physician, and upon agreement from this following physician, for referral and/or further orders, the HHA will note this as the referral date in M0104 (unless referral details are later updated or revised). If a general order to “Evaluate for Home Care services” (no discipline(s) specified) is received from a physician who will be following the patient, this constitutes a valid order, and the RN must conduct the initial assessment visit to determine immediate care and support needs and eligibility for the Home Health benefit for Medicare patients.

M0104 - Date of Referral specifies the referral date, which is the most recent date that verbal, written, or electronic authorization to begin or resume home care was received by the home health agency. A valid referral is considered to have been received when the agency has received adequate information about a patient (name, address/contact info, and diagnosis and/or general home care needs) to initiate patient assessment and the agency has ensured that the referring physician, or another physician, will provide the plan of care and ongoing orders. In the scenario described, if your agency received adequate information as outlined above (including a relevant diagnosis) a valid referral is present on 01/01 to allow the home health admission to be initiated and the M0104 date would be based on the date the referral was received. The assessment process, along with collaboration with the physician, may lead to identification of additional diagnoses for care planning and/or reimbursement purposes.