Referral packet

“Referral packet” is the industry’s word, not a regulation’s. No rule lists its contents, which is why its contents vary. What the rules do fix is what the agency must have before it can bill: a certification that the patient is homebound and needs skilled care, a face-to-face encounter documented in the certifying practitioner’s record, orders, and a plan of care. The packet is the referral source’s attempt to send those, plus the clinical history the admitting nurse needs for the initial assessment visit.

A complete packet carries six things:

• The order or referral for home health, signed by the physician or allowed practitioner.
• The face-to-face encounter note, within 90 days before or 30 days after the start of care, related to the reason for home health.
• The discharge summary, if the patient is coming from a hospital or facility.
• The history and physical, so the admitting clinician is not reconstructing the diagnosis list from the patient’s memory.
• The medication list at discharge, which the drug regimen review in the comprehensive assessment depends on.
• Demographics and payer information, including the Medicare number and the primary and secondary diagnoses.

Hospitals are required to send “necessary medical information pertaining to the patient’s current course of illness and treatment” to the post-acute provider at discharge (42 CFR 482.43). What that obligation produces in practice is a fax of whatever the discharge planner selected, and the face-to-face note and the history and physical are the two pieces most often missing. The agency then chases them against a 48-hour clock, or admits without them.

An outside-records query returns the hospital’s documents directly, from the hospital’s own system, whether or not the discharge planner included them. That is the difference between a packet and a record.