Home Health Audit Checklist 2024

Home Health Audit Checklist: What You Should Know

DRAFT DATE 11/10/12  CERTIFICATION OF AFFIDAVIT. Copy the certification of the patient (SOC. 873) to OHS. OHS is the agency responsible for approving insurance plans for home health agencies. 2. Patient Authorization Sheet Formal The health care organization is authorized to provide the medical services provided by OHS. It is your responsibility to submit the requested documentation by the time specified in the form. OHS will provide the document(s) to OHS by the due date stated on the Authorization Form. This form is also sent to the patient by the HHA. 3. Consent Sheet for Insurance Provider Copy the insurance authorization form (SOC. 873) from the OHS client. 4. Authorization for the Home Health Care Service Copy the insurance authorization form (SOC. 873) from the OHS client. It is important that all the documents be submitted by the due date stated on the Consent Sheet. 5. Patient Authorization Form (Form of Certification) COMPLETE — This form is only needed for patients who have already been seen and certified by the OHS. For patients that will have to be seen by an independent practitioner(s) during the visit the patient will need to fill this form out. This form is sent to the patient by an independent practitioner(s). 6. Written consent form signed by patient Copy the consent form (SOC. 873) from the OHS client. 7. Certificate of Authorization. Copy the authorization form (SOC. 873) from the OHS client. 8. Confirmation from OHS for medical care authorization Copy the authorization (SOC. 873) form from the independent practitioner. 9. Certificate of Care (DOL-0004 or DOL-0005 or DOL-0006 or DOL-0007 or DOL-0004) Complete The documentation is accepted (DOL-0004, DOL-0005, DOL-0006) only when the following is true: 1.) the provider meets the eligibility requirements from the Federal/State Government; 2.) the provider has been authorized by the State Health Commissioner or the State Secretary of Health to provide medical service under the State plan or under a waiver to the Medicare Advantage, Part D, or Medicare Part B plan; and 3.) the provider or primary physician has demonstrated compliance with the State requirements by the time of visit. Complete in duplicate for each appointment.

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