The Business of Home Health

MEL101 · Feb 20, 2004

Interesting....I left an agency a week ago but during my short stay there I was told that if a patient was being DC'd from an acute care fac (hospital) MC would cover visits for 2-3 weeks just to make sure they were "stable"...even if they did not require any other "skilled nursing care"....is this correct?? :)

RubyRN,CHPN · Feb 21, 2004

Interesting....I left an agency a week ago but during my short stay there I was told that if a patient was being DC'd from an acute care fac (hospital) MC would cover visits for 2-3 weeks just to make sure they were "stable"...even if they did not require any other "skilled nursing care"....is this correct?? :)

What your supervisor may have meant was that for pts who have an acute exacerbation of their chronic illness (COPD is a good example) the role of the home health nurse for example may be to assist the pt in transitioning to the home environment by providing ongoing assessment of CVP status, ongoing education, med instruction/management and appropriate community resource referrals. In my home health experience,this can be reasonably accomplished in approx 3 weeks by using specific disease related care paths. When the pt returns to their optimal level of functioning or baseline, if there is no longer any skilled need then discharge. If the pt is not stable or has other variables/complications, certainly would necessite further orders from the MD for ongoing assessment. PPS certainly has made us look at chronic pts and how we take care of them in the home and community. Good patient outcomes are a result of good case management involves good discharge planning by all team members. At our agency, I see few PIP's (partial episode payments) from readmissions to services during the 60 day episode.

EMSnurse · Feb 26, 2004

I work for a privately owned home care agency and I am responsible for making sure the money keeps coming in. At out agency, the nurse who will be doing the initial visit always calls the client to schedule a time and gather pertinent date (info about homebound status, medicare number, etc). If she does the initial assessment and finds them not appropriate or unwilling, then her time and mileage are billed under administrative time. We would never, ever, send a nurse out and not pay her for it. We rarely have a LUPA, unless they are hospitalized prior to 5 visits (or expire), and this is because our nurses are trained and know what to look for on initial assessment. Our agency follows the medicare rule to the nth degree and it has always served us well financially. We also have a good reputation for client care in the community and have good improvement rates. We do put our clients needs first and money second, but we make a real effort to see that all of our staff are educated about medicare rules for payment. That way we get good care for our clients and the owner is happy when he gets his profit statement. Learn everything you can about medicare payment, learn all the rules, and life in home care will be a lot easier and you won't need to fear legal action. I had a hard time with it myself, but now that I understand, I can focus more on people and less on money.

Home Health Columnist / Guide · Feb 26, 2004

all homecare nurses should get the thrill of a lifetime and read the following to understand medicare and the business of homecare:

conditions of participation: home health agencies

http://www.access.gpo.gov/nara/cfr/waisidx_99/42cfr484_99.html

sec. 484.10 condition of participation: patient rights.

the patient has the right to be informed of his or her rights. the

hha must protect and promote the exercise of these rights.

[[page 437]]

(a) standard: notice of rights. (1) the hha must provide the patient

with a written notice of the patient's rights in advance of furnishing

care to the patient or during the initial evaluation visit before the

initiation of treatment.

(2) the hha must maintain documentation showing that it has complied

with the requirements of this section.

(b) standard: exercise of rights and respect for property and

person.

(1) the patient has the right to exercise his or her rights as a

patient of the hha.

(2) the patient's family or guardian may exercise the patient's rights when the patient has been judged incompetent.

(3) the patient has the right to have his or her property treated with respect.

(4) the patient has the right to voice grievances regarding treatment or care that is (or fails to be) furnished, or regarding the lack of respect for property by anyone who is furnishing services on behalf of the hha and must not be subjected to discrimination or reprisal for doing so.

(5) the hha must investigate complaints made by a patient or the patient's family or guardian regarding treatment or care that is (or fails to be) furnished, or regarding the lack of respect for the patient's property by anyone furnishing services on behalf of the hha, and must document both the existence of the complaint and the resolution of the complaint.

care and treatment.

(1) the patient has the right to be informed, in advance about the care to be furnished, and of any changes in the care to be furnished.

(i) the hha must advise the patient in advance of the disciplines that will furnish care, and the frequency of visits proposed to be furnished.

(ii) the hha must advise the patient in advance of any change in the plan of care before the change is made.

(2) the patient has the right to participate in the planning of the

care.

(i) the hha must advise the patient in advance of the right to participate in planning the care or treatment and in planning changes in the care or treatment.

(ii) the hha complies with the requirements of subpart i of part 489 of this chapter relating to maintaining written policies and procedures regarding advance directives. the hha must inform and distribute written information to the patient, in advance, concerning its policies on advance directives, including a description of applicable state law. the hha may furnish advance directives information to a patient at the time of the first home visit, as long as the information is furnished before care is provided.

http://frwebgate.access.gpo.gov/cgi-bin/get-cfr.cgi?title=42&part=484&section=10&year=1999&type=text

home health agency manual

http://cms.hhs.gov/manuals/11_hha/hh00.asp

all the rules and regulations here!

medicare program memorandums

http://cms.hhs.gov/manuals/memos/comm_date_dsc.asp

home health prospective payment system (hh pps)

http://cms.hhs.gov/medlearn/refhha.asp

oasis information

http://cms.hhs.gov/oasis/hhoview.asp

additionally, each medicare intermediary (group responsible for reviewing hh bills for medicare patients and paying for care) has a list of rules they develop to determine if a service is covered. go to your intermediary's website and search for local medical review policies to see what your regs are

in pa, intermediary is cahaba(iowa medicare): http://www.iamedicare.com/provider/provhome.htm

these are our mc policies we must follow:

vitamin b12: skilled nurse administration:

http://www.iamedicare.com/provider/policy/hhab12.htm

foot care: home health

http://www.iamedicare.com/provider/policy/footcare.pdf

blood glucose monitors: in the home

http://www.iamedicare.com/provider/policy/e0607.pdf

home health psych nurse credentialing requirement changed - 10/01/02

hospice - determining terminal status

http://www.iamedicare.com/provider/policy/hospice.htm

find your: part a intermediaries and part b carriers by state