A patient, family member, hospital team, physician, case manager, or social worker can start a conversation about home health. For Medicare-covered home health, an appropriate physician or allowed practitioner must assess the need, certify eligibility, and order the care. A home health agency then reviews the referral before deciding whether it can accept the patient.
That means a referral is a process, not a guarantee of admission or coverage.
The referral process in five steps
1. Identify the skilled need
Start with the clinical reason home health is being considered. Examples might include ordered wound follow-up, nursing assessment and teaching after a hospitalization, or physical therapy for walking and transfers after surgery. Needing general help at home does not by itself establish a skilled home health need.
2. Talk with the appropriate provider
Ask the physician, allowed practitioner, surgeon, or discharge team whether home health is appropriate. For Medicare, the provider’s documentation must support the skilled need and other eligibility requirements, including homebound status when applicable.
3. Choose an agency that can review the referral
Medicare.gov explains that the provider should give the patient a list of agencies serving the area. Patients have a choice of agency, subject to factors such as service availability, clinical fit, coverage, and network rules.
Call the agency before transmitting records. Ask which secure channel to use and what the individual referral requires. Do not send protected health information to an ordinary email address unless the agency confirms an approved secure workflow.
4. Send the case-specific information
The exact packet varies, but an agency may need information such as:
- the ordering provider and current orders;
- the skilled reason for home health;
- a recent clinical note or discharge summary;
- relevant diagnoses, medications, and treatment information;
- face-to-face documentation when required;
- requested disciplines;
- patient contact, location, and coverage information; and
- safety, access, caregiver, or language considerations.
Treat this as preparation guidance, not a universal mandatory checklist. Intake should confirm the exact requirements.
5. Complete agency and coverage review
The agency reviews clinical fit, documentation, eligibility, coverage, staffing, service area, and whether the requested care can be delivered safely at home. Missing information may need to be clarified with the referral source.
If the agency accepts the referral, its clinicians coordinate the plan of care with the ordering provider. Medicare or the patient’s health plan applies the relevant coverage rules.
Questions to ask before sending a referral
- Which documents are required for this patient?
- What is the approved secure transmission method?
- How should I confirm receipt?
- Who handles missing orders or documentation questions?
- Does the patient’s plan require network participation or authorization?
- How will the referral decision be communicated?
If the patient is leaving the hospital
Ask the discharge team who is placing the order, which agency is receiving it, what equipment or medications must be ready, and who to call if the patient’s condition changes before the first visit. Read what happens after a hospital orders home health and the post-hospital care guide for the next part of the process.
For service examples, explore skilled nursing at home and home physical therapy. The Medicare home health hub explains eligibility and benefit rules.
This article is for general education. It does not replace individualized medical advice or determine eligibility, admission, or coverage. Call 911 for an emergency. Healthcare professionals can use the Healing Hands referral pathway; patients and families may request care.