Page 297 - Medicare Benefit Policy Manual

in their patients’ medical records prior to establishing a home infusion therapy plan of
care.

320.5.2 - Plan of Care Periodic Review and Provider Coordination
(Rev. 10547, Issued: 12-31-20, Effective: 01-01-21, Implementation: 01-04-21)

Depending on patient acuity or the complexity of the drug administration, certain
infusions may require more training and education, especially those that require special
handling or pre-or post-infusion protocols. The home infusion process typically requires
coordination among multiple entities, including patients, physicians, hospital discharge
planners, health plans, home infusion pharmacies, and, if applicable, home health
agencies.

For payment purposes, all services billed to Medicare by the qualified home infusion
therapy supplier must be reflected in the plan of care, which is required to be established
and reviewed by the physician. Section 1861(iii)(1)(B) of the Act requires that the plan
of care be established and periodically reviewed by a physician in coordination with the
furnishing of home infusion drugs. This means that the plan of care must be established
and reviewed by a physician in consultation with the suppliers responsible for furnishing
the home infusion drug and related services. “The statute does not specify that the home
infusion plan of care must be established by the same physician who orders the DME and
infusion drugs and signs the detailed written order. It is expected that in most cases the
physician ordering the home infusion therapy services is the same physician ordering the
DME and the infusion drug, however, this may not always be the case. Furthermore, if a
hospital-based physician initially orders the infusion drug and/or the home infusion
therapy services for a patient, they will likely not continue to follow the patient after
discharge; however, in order for the patient to continue to receive home infusion therapy
services, that patient must be under a physician-established plan of care that is reviewed
periodically. Any updates to this plan of care would not likely be made by the hospital-
based physician, rather by whichever physician that takes over the patient’s care after
hospital discharge. In this case, a physician serving as the “applicable provider” as
described in section 320.4 could also be the “ordering physician” as mentioned in section
320.5. Regardless of whether the physician ordering the home infusion drug is the same
physician ordering and updating the home infusion therapy services, there must be care
coordination among all entities in order to meet the plan of care requirements.”

The physician establishing the plan of care is required to consult with the DME supplier
and the home infusion therapy supplier. In order to ensure that home infusion therapy is
safe and effective and stays current throughout the course of treatment, the physician who
orders the home infusion therapy services must review the plan of care on a regular basis
in coordination with the DME supplier. The DME supplier is also required to consult
with the physician prescribing the infusion drug as needed to confirm the drug order and
any necessary changes, refinements, or additional evaluation to the prescribed equipment
item(s), and/or service(s).