For Neurologists, Hospital Discharge Planners, and Case Managers
MS Home Health Care is the MS-specialized program of Focus Family Care, a Medicare-certified home health agency serving all seven South Florida counties. We were built specifically to handle the clinical complexity of multiple sclerosis patients in the home setting — the bladder management, the spasticity protocols, the disease-modifying therapy administration, the heat-related symptom monitoring, and the documentation rigor that protects you and your patients from coverage denials.
This page is for the clinicians and case managers who refer patients to us. Below is everything you need to know about our referral process, our clinical capabilities, and how we communicate back to your office.
What We Need From You
Our chiropractors are licensed professionals with years of clinical experience. With specialized training in spinal health, posture correction, and rehabilitative techniques, we provide safe, effective care for patients of all ages.
We stay up to date with modern methods and combine them with proven chiropractic principles to achieve lasting results.
- Face-to-face encounter documentation (within 90 days before, or 30 days after, start of care)
- Physician order or signed plan of care
- Current medication reconciliation
- Recent neurology consultation notes (preferred but not required)
- Hospital discharge summary (for hospital-to-home transitions)
- Insurance information
- Patient demographics and contact
Documentation Rigor That Protects You
The 2024 Medicare home health improper payment rate was 6.7% nationally, with 51.4% of denials traced to insufficient documentation. We protect your patients (and your referral practice) with rigorous OASIS documentation, complete plan of care development, and proactive communication around homebound status, skilled need, and Jimmo Settlement application for maintenance therapy cases.
Better outcomes at home.
Within 24 hours of referral:
- Insurance verification confirmation
- RN initial assessment scheduled
- Confirmation back to your office that the patient is in care
Within 5 days of start of care:
- Completed OASIS comprehensive assessment
- Plan of care for your signature
- Initial visit clinical summary
Throughout the episode:
- Visit notes after every clinical visit, sent securely to your office
- Immediate notification of any clinically significant changes
- 60-day recertification documentation prepared in advance
- Direct nurse-to-physician communication available on request
- Spasticity management, including stretching, splinting, and antispastic medication monitoring
- Cognitive screening and OT-led cognitive rehabilitation
- Fall risk assessment and PT-led fall prevention programs
- Heat-related symptom management protocols (Uhthoff’s phenomenon)
- UTI prevention — the leading cause of MS hospitalization
MS/ Founder
Our MS-Specific Clinical Capabilities
- Catheter management — straight, indwelling, and suprapubic — for neurogenic bladder
- Disease-modifying therapy administration and patient/caregiver injection teaching
- Intrathecal baclofen pump coordination
- Dysphagia screening and SLP referral protocols (aspiration risk in advanced MS)
- Pressure injury prevention protocols for non-ambulatory patients
Working With South Florida Hospital Systems
We accept referrals from and coordinate with all major South Florida hospital systems including Baptist Health, Cleveland Clinic Florida, Memorial Healthcare System, Jackson Health System, NCH Healthcare, Tenet Healthcare facilities, HCA Florida, and the Veterans Health Administration. For hospital-to-home transitions, we can complete bedside intake and have care started before discharge.
Working With MS Specialty Centers
We coordinate care with MS specialty centers and comprehensive care programs throughout South Florida — including university-based MS centers, neurology group practices, and infusion clinics. If your patient is enrolled in a specific MS care program, we work with that team rather than around them.
Quality Metrics
- CMS Care Compare star ratings — published quarterly at medicare.gov/care-compare
- HHCAHPS patient satisfaction surveys — independently administered
- ACHC and CHAP accreditation standards (where applicable)
- OASIS quality measure tracking
- 30-day readmission tracking and reporting
Contact us
Ready to Refer?
Call Us 24/7
Available 24 hours a day, 365 days a year. Talk directly to someone who understands MS — not a call center.
Online Intake Form
Fill out the secure form below. We respond within 2 hours during business hours, the next morning if you reach us overnight.
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