CMS-485 | e-485 (extended version of CMS-485) | CCR (Continuity of Care Record) | |
---|---|---|---|
1 | Patient HI Claim No. | Patient HI Claim No. | |
2 | Start of Care Date | Start of Care Date | <PlanOfCare><Plan><DateTime> |
3 | Certification Period | Certification Period | <PlanOfCare><Plan><DateTime>** |
4 | Medical Record No. | Omitted | Omitted |
5 | Provider No. | Omitted | Omitted |
6 | Patient Information | Patient Information | <Actor> |
7 | Provider Information | Provider Information | <Actor> |
8 | Date of Birth | Date of Birth | <Actor> |
9 | Sex | Sex | <Actor> |
10 | Medications | Medications | <PlanOfCare><Plan><OrderRequest> |
Medication Adjustment | <PlanOfCare><Plan><OrderRequest> | ||
Physician Notification | <PlanOfCare><Plan><OrderRequest> | ||
11 | Principal Diagnosis | Principal Diagnosis | <Body><Problems> |
11 | Other Diagnosis | Other Diagnosis | <Body><Problems> |
12 | Surgical Procedure, date, ICD-9 code | Surgical Procedure, date, ICD-9 code | <Body><Problems> |
13 | Other Pertinent Diagnosis: date of onset/exacerbation | Other Pertinent Diagnosis: date of onset/exacerbation | <Body><Problems> |
14 | DME and Supplies | DME and Supplies | <PlanOfCare><Plan><OrderRequest> |
15 | Safety Measures | Safety Measures | <PlanOfCare><Plan><OrderRequest> |
16 | Nutritional Requirements | Nutritional Requirements | <PlanOfCare><Plan><OrderRequest> |
17 | Allergies | Allergies | <Body><Alerts> |
18A | Functional Limitations | Functional Limitations | <Body><Problems> |
18B | Activities Permitted | Activities Permitted | <PlanOfCare><Plan><OrderRequest> |
19 | Mental Status | Mental Status | <Body><FunctionalStatus> |
20 | Prognosis | Prognosis | <Body><Problems> |
21 | Orders for Discipline and Treatments | Orders for Discipline and Treatments | <PlanOfCare><Plan><OrderRequest> |
22 | Goals | Goals/Rehab | <PlanOfCare><Plan><DischargePlan> |
22 | Discharge Plan | Discharge Plan | <PlanOfCare><Plan><DischargePlan> |
22 | Rehab Potential | Rehab Potential | <PlanOfCare><Plan><DischargePlan> |
Notes:
Since the e-485 was for start of home care, the start of the certification period = the start of the care date.
It is not clear from the CCR documentation where to put financial certification information.