Which outcome occurs when the hospitalist refuses to sign the care plan?

• A. The referral remains valid
• B. The referral is not valid
• C. The patient is referred to another agency
• D. The discharge is delayed

Answer: (B)

The essential point is that a home health referral hinges on a physician signing the plan of care. The plan of care authorizes skilled services and confirms medical necessity, so without the hospitalist’s signature, there is no valid authorization to proceed. Therefore the referral is not valid and the agency cannot initiate services or bill. In practice, to move forward, another physician’s signature would be needed or a new, signed plan of care would have to be obtained. The other outcomes aren’t the immediate consequence of a missing signature because they assume the plan has been authorized, which isn’t the case here.