Service Scope & Methodology
A defective or misaligned CMS-485 Plan of Care is one of the most common triggers for Medicare claim denials and audit recoupments. Four Pillars meticulously reviews every section of the Plan of Care—from homebound status justifications and discipline-specific visit frequencies to measurable rehabilitation goals and physician signature dates. We ensure every discipline operates under signed, valid orders that withstand state surveys and fiscal intermediary scrutiny.
Key Scope of Work & Clinical Deliverables
CMS-485 Structural & Clinical Validation
Review of all 28 boxes on CMS-485 including diagnoses, surgical procedures, durable medical equipment (DME), and safety precautions.
Visit Frequency & Duration Cross-Checks
Verifying that skilled nursing, PT, OT, ST, and MSW visit frequencies match clinical need and match actual visit notes submitted.
Comprehensive Medication Reconciliation
Cross-referencing medication profiles against hospital discharge orders, identifying drug-drug interactions, and confirming route and dosage.
Measurable Goals & Rehabilitation Potential
Ensuring therapy and nursing goals contain objective, measurable benchmarks and timeframes as required by Medicare guidelines.
Verbal Order & Addendum Verification
Tracking verbal orders, change of order addenda, and interim physician orders to maintain continuous coverage and valid physician oversight.
Physician Signature Timeliness Tracking
Monitoring 60-day certification and recertification signature cycles to prevent billing holds and claim submission delays.
Supported Electronic Health Records (EHRs)
Our teams work natively inside your agency's existing EHR environment using secure, direct-access credentials with zero disruption to field clinicians:
Request a Chart Audit
Interested in Plan of Care Review? Connect with our operations team for a confidential turnaround assessment and sample audit.