Simple, Compliant Home Health Referrals.
Saintly Home Health makes it easy for physicians, NPs, PAs, and MA staff to refer and manage Medicare home health patients. We provide the 485s, F2F templates, and support you need — you simply review and sign.
Medicare-Compliant Documentation Checklist
We keep your practice compliant and make the paperwork as simple as possible. Our team pre-fills forms and sends them to your office ready for review and signature.
Initial and ongoing orders for:
- Skilled Nursing (SN)
- Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy (ST)
- Medical Social Worker (MSW), Home Health Aide (HHA)
- Wound care, catheter/ostomy care, teaching, monitoring
How it works: You can fax existing orders to us, or we can send a pre-built order set for you to sign.
Medicare requires a documented F2F encounter:
- Performed within 90 days before or 30 days after start of care
- Includes diagnosis & reason for skilled services
- Documents why the patient is homebound
- Includes encounter date, provider signature, and credentials
We provide simple, compliant F2F templates that your providers can sign in seconds.
We generate and send the full Home Health Plan of Care (CMS-485) for your approval:
- All disciplines, visit frequency, and duration
- Goals, interventions, and safety precautions
- Medications and treatments
- Start-of-care and certification period dates
The 485 must be signed every 60 days. We track all due dates and send timely reminders.
When you sign the 485, you are also certifying that:
- The patient is under your care
- The patient is homebound as defined by Medicare
- The patient needs intermittent skilled nursing or therapy
- The plan of care has been reviewed and approved
We clearly mark certification and recertification dates so you always know what you are signing and why.
When available, the following documents help us provide safer, more coordinated care:
- Recent office visit notes or H&P
- Hospital or SNF discharge summary
- Recent labs, imaging, or consult notes
- Updated medication list
If you prefer, our team can work with your MA or staff to obtain what’s needed directly.
How Our Referral Process Works
We designed the process so your office team can follow it quickly and easily — whether it’s the physician, NP/PA, or MA sending the referral.
Fax or email any of the following:
- Face sheet / demographic info
- Diagnosis and reason for home health
- Recent visit note or discharge summary
- Any existing orders for home health
Fax: (480) 808-7157 | Email: saintlyhomehealth@gmail.com
Our team will:
- Draft the 485 Plan of Care
- Pre-fill the F2F documentation for your review
- Create discipline-specific orders (SN, PT, OT, ST, MSW, HHA)
- Send everything back to your office for quick signature
We are happy to work directly with your MA or office manager to keep this fast and organized.
Once we have the referral and initial orders:
- We contact the patient and schedule Start of Care (SOC)
- Complete the OASIS assessment and home safety review
- Confirm meds, risk factors, and homebound status
- Begin communication with your office on the care plan
Urgent referrals can often be seen same day depending on location and staffing.
How We Help Prevent Hospital Readmissions
Our clinicians are trained to identify problems early and communicate with your office before issues escalate.
On each visit, our team assesses:
- Vitals and cardiopulmonary status
- Blood sugar and diabetic control
- Pain level and medication effectiveness
- Wound healing, catheter/ostomy status
- Fall risk, balance, and home safety
Any concerning changes are reported to your office promptly with clear recommendations.
We maintain ongoing communication with your practice:
- Updates on clinical status and progress toward goals
- Requests for new or updated orders when needed
- Early notification of symptom changes or red flags
- Coordination for follow-up appointments and labs
Our goal is to manage issues at home whenever safely possible and avoid unnecessary ER visits.
Quick Reference for Your MA or Office Team
- Fax referral & face sheet to: (480) 808-7157
- Include diagnosis, recent note, and any orders if available
- We will send back: 485 and F2F form for signing
- We track signatures and recert dates for you
Common reasons to refer to home health:
Why Physicians Trust Saintly Home Health
We act as an extension of your practice — clinically strong, highly communicative, and serious about compliance.
- We provide all templates (485, F2F, orders)
- Clear instructions for your staff on every fax
- Electronic or fax-based signature options
- One point of contact for your office
Our goal is to reduce work for your clinic team, not add to it.
- Skilled nursing, therapy, social work, and aides
- Medicare-compliant documentation and OASIS
- Timely 485 cycles and recerts
- Emphasis on safety, education, and hospital avoidance
We are committed to excellent patient care and clean, survey-ready documentation.