Intake Referral Form - PDGM : CLOSEOUT ITEM

The Intake process has been impacted under PDGM.

Briggs’ Intake Referral Form – PDGM #3534P helps the intake staff get it right from the start! It facilitates accuracy, completeness and efficiency to help agencies adjust to the new 30-day billing cycle.

This form pulls all the details together by prompting the intake staff to obtain all the required information, at the time of the intake, to successfully complete a proper referral.

Areas of data collection address:

•Demographics

•Insurance / Eligibility

•Emergency Contact / Representative

•Referral Source / Certifying Physician

•Acceptable primary diagnosis and pertinent secondary co-morbidities

•F2F / all pertinent supporting documentation

•Services Ordered

The back of the form offers a list of suggested documentation from the referral source and a checklist/review to support the completion of a valid referral.

Download a sample today!