A referral is only useful if your team can act on it. When a discharge planner calls and the intake sheet comes back missing payer details or the ordering physician, the morning team spends hours chasing what one complete call could have captured.
Use this checklist to standardize home health referral intake across day, evening, and weekend calls.
The referral intake checklist
Capture these fields on every new referral, whoever answers the phone.
- Referral source: facility or practice, contact name, direct callback, and fax
- Patient: legal name, date of birth, address, phone, and emergency contact
- Payer: primary and secondary insurance, member ID, and any authorization needed
- Clinical: primary diagnosis or reason for care, recent hospital stay, and services ordered
- Timing: discharge date and requested start of care
- Physician: ordering provider and who will sign the plan of care and follow the patient
- Face-to-face: encounter date and who documented it, if already known
- Home safety: who lives with the patient, pets, access issues, and preferred language
Why each group of fields matters
Medicare home health certification requires a face-to-face encounter related to the primary reason for care, within 90 days before or 30 days after the start of care (42 CFR 424.22). Asking early prevents a scramble at billing.
Under the Patient-Driven Groupings Model, admission source and timing affect payment grouping. Recording whether the patient came from an institution or the community gives your team a clean start.
Payer details decide whether you can accept the case at all. Geography and start date decide whether you can staff it. A referral without those fields is a callback, not an admission.
Separate must-have from nice-to-have
Discharge planners are busy. If your intake script asks 30 questions in fixed order, they will send the referral to the next agency on the list. Split fields into two tiers.
- Must capture on the call: source, patient name, date of birth, location, payer, service needed, and requested start date.
- Can follow by fax or portal: full demographics, medication list, and history and physical.
The test of a good intake call is simple: could your admissions nurse accept or decline this referral without calling anyone back?
Make it the same at 2 p.m. and 9 p.m.
Intake quality usually falls apart outside office hours, when calls go to a general answering service with a short script. Grace, the KareOps.AI home care intake specialist, follows the same field list every time and passes the record to your team. See home health and hospice for workflow detail.
Whatever tool you use, audit a sample of referrals each week and count how many required a second call. That number tells you whether the checklist is working. Our guide to after-hours answering and referral intake covers the overnight side in more depth.
Frequently asked questions
What information is needed for a home health referral?
At minimum: referral source, patient name and date of birth, address, payer, reason for care, services ordered, requested start date, and the physician following the patient. Confirm requirements with your own admissions team.
When must the face-to-face encounter happen?
For Medicare home health, within 90 days before or 30 days after the start of care, and related to the primary reason for home health. See 42 CFR 424.22.
Can referral intake be automated?
Field collection, payer capture, and routing can be automated. The decision to accept a patient stays with your clinical and admissions team.
Run your intake checklist on every call
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