The plan of care must include all services, frequency, duration, and specific orders — vague orders like 'PT as needed' are not acceptable

Ensure the face-to-face encounter documentation supports the homebound status and need for skilled services

Timely physician signature is critical — delays can hold up billing and reimbursement

Home HealthhardDoctor signature required

Home Health Certification and Plan of Care

CMS-485 · CMS

Documents the home health treatment plan including diagnoses, medications, services ordered, frequency, and goals. Must be signed by physician. Reviewed and rewritten every 60 days.

Form Details

Total fields: 55
Auto-fillable: 30 (55%)
Time without BeneFill: 45 minutes
Time with BeneFill: 14 minutes
Time saved: 31 minutes
Filled by: both
Frequency: as needed

Fill this form with BeneFill

Auto-fill 55% of fields from your profile. Save 31 minutes. Download a real PDF.

30 of 55 fields55% auto-filled

Start Filling Upload Your Copy Instead

Where to Submit This Form

📠

Fax to the certifying physician for signature

The home health agency prepares the CMS-485 (Plan of Care) and sends it to the physician for review and signature.

📬

Mail to the certifying physician if fax is unavailable

Filing Deadline

Must be signed by the physician before the first billing period and recertified every 60 days for continued home health services.

Required Attachments

📎 Completed CMS-485 Home Health Certification and Plan of Care
📎 Face-to-face encounter documentation (within required timeframe)
📎 OASIS assessment data supporting the plan of care
📎 Orders for all skilled services, medications, and DME
📎 Physician signature and date

Processing Time

Physician should sign and return within 5-10 business days. Medicare requires the signed plan of care before the first billing submission.

What Happens Next

The signed CMS-485 authorizes the home health agency to provide and bill for the skilled services listed. It must be recertified every 60 days. The physician must review and sign updates to the plan of care.

Tips for This Form

✓ The plan of care must include all services, frequency, duration, and specific orders — vague orders like 'PT as needed' are not acceptable
✓ Ensure the face-to-face encounter documentation supports the homebound status and need for skilled services
✓ Timely physician signature is critical — delays can hold up billing and reimbursement
✓ Keep a tracking system for 60-day recertification deadlines to avoid lapses in authorized services

More Home Health Forms

OASIS Assessment

OASIS-E (CMS) · CMS

Outcome and Assessment Information Set. Standardized data elements integrated into comprehensive assessment for Medicare home health patients. Includes socio-demographics, functional status, health conditions, and service utilization. Used for quality reporting and payment (PDGM).

Face-to-Face Encounter Documentation

F2F Encounter (CMS) · CMS

Required documentation of a face-to-face encounter with the patient within 90 days before or 30 days after the start of home health. Must document homebound status and need for skilled services.

Home Health Aide Authorization

HHA Authorization (agency-specific) · Home Health Agencies

Authorization and care plan for home health aide services. Documents specific tasks the aide may perform, schedule, and supervisory requirements. RN supervisory visits required at least every 14 days.

Not sure which forms you need?

Tell our assistant about your situation and we'll find the right forms for you.

Chat with Form Assistant

Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the CMS or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.