[JennyHHRN]

Can a patient be admitted for HH visits just so someone can flush her port once per month? The doctor certifies that she is homebound. The port is not currently in use. They keep it r/t her recent (2mos ago) hx of needing transfusions for anemia.

The doctor argues that urinary catheters are covered to be changed once per month by a HH RN so why not flush a cath?

I can't find any verbiage in the medicare manuals regarding this.

[Cattitude]

Hmmm. My Long term program allows once a month visits under medicaid. I'm doubtful if Medicare allows that. It's almost like a catch 22. The pt. is sick enough to be homebound but not sick enough to need weekly visits? see what I mean?

Would the MD allow you to visit weekly? But then what would you chart on if port only needs monthly flush? Does she have other dx that you could do skilled care ?

And exactly how long does MD think this could stretch ou to anyway?

[NRSKarenRN]

This is a catch 22 situation.

A. Medicare does not pay for infusion therapy in most instances.
Who is paying for equipment: Huber needle and flush solution???
If patient has secondary insurance in addition to Medicare, they will pick up cost of supplies and often nursing visit, usually they bundle cost SN visit included under secondary and provide via infusion company if your agency does not provide this service. Cost for supplies alone I think is less than $50.000 ----this is the first hurdle to consider.

B. Medicare WILL pay for a nurse to administer IV therapy if patient/caregiver can not be taught (DOCUMENT lack of dexterity, unable reach location etc and homebound status extremely well) if payment for supply issues resolved. This would be a LUPA payment if visit is only monthly port mgmt.

C. What is type of anemia has been diagnosed. Any co-morbidities
Can teaching be done re diagnosis, eval/ instruct nutrition and hydration, calorie count etc, instruct med managment, labs to monitor H/H, B12 level etc., eval compliance with POC..... This could be done on weekly basis first month, then 2x month especially if co-morbidities, pt lives alone or multiple unskilled caregivers, eval risk falls if frail, eval forgetfulness etc. Thus, port flush is secondary to above care activities.

Recert must show PATIENT CHANGES: getting weaker, non-compliance med regimen, or med changes or improvement till goals met. Document homebound status each visit.

D. If patient truly stable and unable bill medicare, get MC form signed for denial, and bill to secondary insurance if pt has one.


See links here: http://allnurses.com/forums/f23/4-06...ted-90744.html

[JennyHHRN]

The plot thickens.
We ran an insurance check and this patient is not Medicare, she's Blue Cross/Blue Shield (husband works full time). But in our state Blue Cross mirrors Medicare policy. We are required to conduct OASIS assessment on all Blue cross patients, that in itself worried me: If we perform the Oasis admit visit but only see her once, would we have to do a non charge d/c visit to complete DC OASIS? That would use up any reimbursement we would get from the 1st visit.
We also found out this patient has a broken leg (sustained injury 2 mos ago while out of state), and is nwb., I thought perhaps we might find a skilled reason r/t fracture such as pain mgmt or something like that, but from what the office nurse states, she is not having any issues currently! UUUUUGGGHHHH.
I called an infusion company we work with a lot and they said mediport maintenance is not a covered service in the home if the patient is not currently receiving any type of IV therapy through the port. The insurance expects the patient to have port flushed in the physicians office or outpt infusion center. Our town does not have an outpt infusion center.
I welcome any and all feedback on this issue.

[jhlynngirl]

the mediport must be maintained. A hisory of anemia is a good reason for a port, certainly if she does not have any veins? A port flush takes 2 minutes.

[dria]

ah....ya'll got me..this is from feb...forget it....

[NRSKarenRN]

I called an infusion company we work with a lot and they said mediport maintenance is not a covered service in the home if the patient is not currently receiving any type of IV therapy through the port

This is most often the case... However, it can be offered as a private pay service if your agency chooses to provide this type of care and pt/family willing to pay out of pocket.

[caliotter3]

We worked a case one time where the family members did everything for the patient and the nurse was simply sitting there and assisting as requested. It was a little taxing because the family members would speak about the circumstances behind the event leading to the condition of the patient. We were like a back up unit. I always talked to the family members about the time when they could find the nurses that they could trust to leave the patient with while they got much needed sleep or respite. These people were running themselves ragged. I know this is not related to your thread, but your thread reminded me of this instance where I wondered why the agency was providing nurses at all. It seemed like such a waste at the time. The criteria for home care reimbursement was there, but the family was not really properly utilizing their benefits. I hope that someday they were able to trust their nurses and get the rest that they so badly needed.

[ragtopnurse]

Originally Posted by JennyHHRN

Can a patient be admitted for HH visits just so someone can flush her port once per month? The doctor certifies that she is homebound. The port is not currently in use. They keep it r/t her recent (2mos ago) hx of needing transfusions for anemia.

The doctor argues that urinary catheters are covered to be changed once per month by a HH RN so why not flush a cath?

I can't find any verbiage in the medicare manuals regarding this.

No, Medicare doesn't see port flushes as a skill to keep patients solely for that, but we can keep them for monthly B12 injections if they have a diagnosis of pernicious anemia, now tell me how that makes sense. I would much rather have a family member give me a IM injection than to teach them to flush my port, but that is the great system of Medicare for you.

[homehealth43130]

Medicare will only cover med port flushes to maintain a port for 3 months per Palmetto GBS.