485's

renerian, BSN, RN · Sep 20, 2003

Now I have worked for small and large, mom and pop and corporations and each one liked things done a certain way.

Here are some tips:

goals with outcomes/time frames

ranges for bloodwork/theraputic as determined by Dr.

precise decription of proceedures/frequency

frequencies

(some companies go by work week, calander week or the first day is the start of care and the weeks match the first day of the open ie) tuesday to tuesday would be week one

It teaching who/retention measure goals

Let me think some more and I am sure I can come up with something else LOL.

renerian

britmess · Sep 20, 2003

Thank You Renerian, I'm still puzzled. I f I have a patient on Medicare with a 60 day certification time frame, if I say 'will verbalize understanding of low salt diet in 7days' are they then ready for discharge? I won't get paid for that. Do I extend the time frame to 'at discharge pt will verbalize etc.'

renerian, BSN, RN · Sep 20, 2003

I would say something like the patient will verbalize understanding of a low salt diet in 7 days. You can pick the time that you think the client will be able to verbalize those things to you. Document what you taught, their retention and if they retained it or if they did not. When you are paid ,you are paid a lump sum based on where they score out on the oasis. You can always discharge them earlier if they meet their goals and you are still paid the same amount. My goals were always timed out different. The only exception would be if you saw them of very short duration and then you would be paid per visit as in if you had a case you knew would be for one week or something.

goal 1: patient will verbalize understanding of low salt diet within 14 days.

goal 2: patient will be able to demonstrate how to do a blood pressure reading within 14 days.

goal 3: patient will be able to verbalize medication use, purpose and side effects within 3 weeks.

goal 4: patient patient will be able to verbalize signs of CHF in one week.

So on and so forth. Does that help?

renerian

britmess · Sep 23, 2003

Thanks, that helps a lot.

britmess · Sep 27, 2003

Thank you Renerian, I think I've got it. I bought and studied the 'Little Red Book' and it all seems much less threatening. I still have a little issue with time frames but will be attending a seminar on that issue next week and, hopefully, they will set me straight. I appreciate your help.

renerian, BSN, RN · Sep 27, 2003

Oh good brimess. Remember that the way of doing things always changes with regard to home health documentation. The surveyors get certain things that they hone in on every year LOL. Always tweeking to be done.

Glad the little red book helped.

renerian

Shell7280 · Oct 4, 2003

On Tuesday I will start working at a home health agency. It is a new agency in the area, and I've also not really done any home health. I know I will be working mostly in the office, kind of case manager, but with additional things also, not sure of everything yet. They want to train me to be in charge! lol. :) Yikes! What is this Little Red Book your talking about? I think 485's are care plans? I just don't wanna go in looking ignorant. :).

britmess · Nov 2, 2003

Sorry Shell, I missed your post. The little red book is indexed by medical condition and then goes on to show ICD9's, SN POC, PT POC, Nursing diagnosis, outcomes, etc. It also gives guidelines for documentation to enhance chances for payment, guidelines for homebound status. However, I am not at the office and cannot remember it's real name or publisher, I bet Renerian knows. I will post it tomorow (Mon) when I get to work. I also have some excellent 'cheat sheets' for writing 485's if you are interested.

Home Health Columnist / Guide · Nov 2, 2003

The Little Red Book:

Handbook of Home Health Standards and Documentation -- Guidelines for Reimbursement, 4th Edition

by Tina M. Marrelli

Publisher Mosby

about $35.00

Wallmart.com has it for $32.95

http://www.walmart.com/catalog/product.gsp?product_id=1133345&cat=19166&type=3&dept=3920&path=0%3A3920%3A18571%3A18576%3A18581%3A19166

This book really helped me with writing goals for care plans...now I can write them in my sleep.

rnhomeind · Nov 6, 2003

In our agency, for all 485s, we set most goal dates on a 21 day goal time period. Some goals that I feel would quickly get met, I will state, "Caregiver/client able to verbalize adverse symptoms of lovenox injections, by (insert a 7day goal date)." Longer goals, I always use a standard 3 week period and at that time reevaluate the goal, clients status, ability to retain instructions and adjust accordingly. If they have a chronic wound, I still try to put a goal date of 3 weeks (usually not a healed goal, but decrease in size by 25% or QD wound care to be decreased to 3x per wk by..), and at the 3 week time, if wound has not responded to current regimen, I change the plan of care and try a different wound care. (Especially with the medicare). If it is private insurance, sometimes, we only have couple of visits to meet our goals and I adjust the dates accordingly.

All clients have the goal of "will adhere to medication and treatment regimen as prescribed per MD BY .... & ABLE to verbalize correct medications dosages, times and adverse effects to report to MD by....; the other goals, change just according to the clients disease processes.

Good luck...:)