Home health and hospice referrals

How do we package a home health or hospice referral with the orders, the face-to-face documentation and the coverage, send it to the agency, and track the acceptance?

Build the referral the agency can admit on, and chase the agency until the start of care is booked. When a discharging provider refers a patient to home health or hospice, Callvu prefills the referral from the EHR (the patient, the coverage, the diagnoses, the orders for the disciplines and the frequency, the medications, the home situation, the caregiver), classifies the payer coverage rules for the benefit (the homebound and skilled need requirements, the face-to-face encounter and its documentation, the certifying physician, the hospice terminal prognosis certification, the agency network), chases the certifying physician for the signed orders and the face-to-face documentation and the patient for the agency choice and consent, sends the package to the chosen agency through its link, tracks the acceptance and the start of care date, routes a decline or a coverage gap to the case manager in the Decision Desk, and writes the acceptance and the start of care to the EHR.

In scopeComplex: multi-party handoffsCallvu moves: prefill, chase and verify, write back

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Last updated November 7, 2026.

The problem today

The agency could not admit because the face-to-face note did not say why the patient was homebound, and the patient went a week without nursing.

Today, without Callvu

A home health referral looks like a fax with orders. The agency needs more: the face-to-face encounter documented by the physician with the clinical findings that support the homebound status and the skilled need, the signed orders with the disciplines and the frequency, the certification, the coverage and the authorization where the payer requires one. Missing any of them, the agency cannot bill, so it does not admit, and the patient sits at home between the hospital and the care that was ordered.

The payer coverage rules for home health (the homebound and intermittent skilled need requirements, the face-to-face encounter within the window and its contents, the plan of care certified by the physician) and for hospice (the terminal prognosis certified by two physicians, the election with its disclosures, the benefit periods) are specific, and the agencies audit referrals against them because their payment depends on it. The referral is a package with a checklist, and the acceptance is a chase.

A referral that arrives complete is a start of care within days.

How it runs

From the requestto the system of record.

A discharging provider orders home health or hospice in the EHR, or discharge planning routes to a home setting. Callvu opens the referral.

Certifying physician: Signs the orders and the certification, and supplies the face-to-face documentation.
Patient or caregiver: Chooses the agency, confirms the home situation and signs the consent or the hospice election on their phone.
Agency: Receives the package through its link, accepts with a start of care date, and reports the admission.
Case manager: Decides declines and coverage gaps in the Decision Desk.
Callvu: Prefills, classifies the coverage rules, chases, sends, tracks, routes and writes back.

Prefill and classify
The referral is prefilled from the EHR (the patient and coverage, the diagnoses, the ordered disciplines and frequency, the medications, the equipment, the home situation and the caregiver, the discharge date); the payer and the benefit classify the coverage rules: the homebound and skilled need criteria, the face-to-face encounter window and its required contents, the certifying physician, the plan of care, the authorization where required, the agency network, and for hospice the terminal prognosis certification, the election and the disclosures.
Chase and verify
The signed orders and the certification are generated for the physician's signature, the face-to-face documentation is checked for the date and the clinical findings the rules require (why the patient is homebound, what skilled service is needed) and chased from the physician through their inbox task with the specifics where it falls short; the patient or caregiver is shown the agency list with the quality data, chooses, confirms the home situation and signs the consent or the hospice election on their phone; each item is checked against the benefit's checklist.
Send and track
The complete package is sent to the chosen agency through its link, the authorization is requested in parallel where the payer requires it, the agency is chased for its acceptance and the start of care date on a clock set from the discharge date, and a decline (no capacity, out of area, the payer not contracted), a coverage gap or a face-to-face that cannot be cured goes to the case manager in the Decision Desk with only the allowed outcomes (send to the next chosen agency, change the plan, arrange an alternative, or document the patient's informed decision).
Write back
The acceptance, the agency, the start of care date and the authorization are written to the EHR, the agency reports the admission and the plan of care for the physician's signature through its link, the patient is told when the first visit is, and the post-discharge follow-up reads the start of care.

Where it ends: The referral left with the face-to-face documentation, the signed orders and the coverage the agency needs, the patient chose the agency, and the EHR holds the acceptance and the start of care. The Decision Trace shows the coverage rules, the checklist and any decision; the Audit Trace shows the chases, the package, the agency's acceptance and the write with time.

Runtime enforcement

What is enforcedwhile the work runs.

The regulations preloaded in Callvu Studio and the bank's own policies, applied as steps that run, not lines in a binder. A step that breaks a rule does not run, so a completed run was compliant.

Regulations

Payer coverage rules: Medicare home health coverage (42 CFR 409.42 to 409.45 and 424.22) requires that the patient be confined to the home, need intermittent skilled nursing or therapy, be under a plan of care established and periodically reviewed by a physician or allowed practitioner, and have a face-to-face encounter related to the primary reason for home health within ninety days before or thirty days after the start of care, documented with the clinical findings supporting homebound status and the skilled need; Medicare hospice (42 CFR 418) requires certification of a terminal prognosis of six months or less by the hospice medical director and the attending physician, the patient's election with the required disclosures, and the benefit periods; commercial payers and state programs add authorizations and networks.
CMS discharge planning conditions of participation (42 CFR 482.43): The hospital must provide the list of home health agencies and hospices that participate and serve the area with the quality data, respect and document the patient's choice, and send the necessary medical information to the agency at transfer.
HIPAA Privacy Rule disclosures for treatment (45 CFR 164.506): The package sent to the chosen agency is a disclosure for treatment; the information sent to agencies not chosen is limited to what their acceptance decision needs.

Company policies

The face-to-face documentation is checked for the findings the rules require before the referral is sent; the agency never discovers the gap.
The patient chooses the agency from the list with the quality data and signs the choice and the consent or election.
The agency is chased to a start of care date set from the discharge date.
The EHR is the system of record for the referral, the acceptance and the start of care.

Controls

Referral prefill from the EHR.
Coverage rule classification by payer and benefit.
Orders and certification generation with physician signature.
Face-to-face documentation check and chase.
Patient choice and consent capture.
Agency package delivery, acceptance tracking, Decision Desk and EHR write.

Clocks and deadlines

Face-to-face encounter window: Within ninety days before or thirty days after the start of care for home health.
Start of care: The agency's date, chased from the discharge date and written to the EHR.
Plan of care signature: The physician signs the agency's plan of care within the payer's period.

Documents and checks

The prefilled referral and the coverage checklist
The signed orders, the certification and the face-to-face documentation as checked
The patient's agency choice and consent or election
The package, the acceptance and the start of care
The EHR record

In the Decision Trace

The coverage rules and the checklist.
Each document against the checklist.
Any decision and the person.

In the Audit Trace

Each chase and arrival with time.
The patient's choice with time.
The package sent, the acceptance and the write.

The handoff

Between the front doorand the back office.

The front door

The EHR order; the physician's inbox for the signature and the face-to-face note; the patient's phone for the choice and the consent; the agency's link.

The back office

The case manager sees the acceptance on the case and decides only declines and gaps; the agency receives complete referrals.

The Decision Desk

An agency decline, a coverage gap or a face-to-face that cannot be cured goes to the case manager in the Decision Desk with only send to the next agency, change the plan, arrange an alternative, or document the patient's informed decision.

Proof

In scope.Proof at scale, not one process at a time.

The kind of process Callvu runs in production for customers in this industry. Ask for a reference on this exact process. The results below are the industry's published proof; each claim code links to its record on agents.callvu.com.

23 hospitals in the Ministry of Health network run on Callvu.

Across Callvu customers

More than 1,000 processes are live across Callvu customers.

Across Callvu customers

Questions

What buyers ask next,answered plainly.

What does the agency need to admit?

The signed orders with the disciplines and frequency, the certification, the face-to-face documentation with the findings supporting homebound status and the skilled need, the coverage and the authorization where required; the process checks each before sending.

How is the face-to-face checked?

For the encounter date within the window and the clinical findings the rules require; a note that falls short is sent back to the physician with the specifics before the referral goes.

What if the agency declines?

The case manager decides in the Decision Desk: send to the patient's next chosen agency, change the plan, arrange an alternative, or document the patient's informed decision.

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