Calling all HH Nurses, roll call - page 3

Hi, as a newly appointed moderator, I want to live this forum up a bit. I just resigned my position as a HH supervisor, to go back to the field. I have been a nurse 20 years, 17 in critical care,... Read More

  1. by   LoisJean
    Welcome, Leader (and Deb, too); Hi, Hoolihan! It's been awhile since I've been able to post.

    Medicaid cuts have been our problem of late. Since mine is an independent home care business we have some leeway in deciding how best to continue serving our clients on an out of pocket basis....still, I believe that no matter what the circumstance or situation, Home Health Care is all I'll ever want to do! I love it so! Thanks for your post, Leader.

    Lois
  2. by   SikeRN
    I have been a psych HH RN for over a year. Prior to that I worked in community mental health and psych crisis. I tried the med surg thing recently and hated it! I had NO time to get to know my patients or even educate them. Plus, the loss of autonomy was frustrating. I love being out there, making an assessment, calling the doc, and getting my orders without fighting (usually ). This is what I love and where I belong. In all reality, at least I have time to complete all the paperwork rather than stay at work for 16 hours to finish it all.
  3. by   hoolahan
    Amen sister!!

    Welcome SikeRN, love that name! Good to know we have a HH psych "consultant" on the site!

    Hi Lois, where ya been?? Missed ya!
  4. by   Karen4HIM1951
    HI!
    I'm new to message boards - Wanted to let you all know that I am a Home Health Nurse too - have been an RN for 27 years - have been in Home Health for the last 7 years!

    I too love HH but am getting so-o-o frustrated with the paperwork. Having trouble keeping up (and out of trouble).

    Don't know if I'm getting to old for this - or if my health is interfering - OR WHAT!

    Can't imagine doing anything else and am unable to "work the floor" at a hosp. or NH (due to a car accident that I had "in the line of duty" prohibiting my being on my feet for that long).

    I can use any suggestions/help with managing the paperwork without working all of my off time to keep up! I work full time!

    Even it you have no suggestions - would be glad to talk and to find out what others over 50 or Nurses with health problems are doing and how other HH nurses are handling the paperwork!!!
  5. by   hoolahan
    Hi Karen,

    Welcome.

    The paperwork? Yes, it bites, for sure, but I look at it this way, at least I can do it at home. If I were in a hospital, I'd have to stay OT until all my work was done.

    I think it depends a lot on the processing of the paperwork in the office. If the process of referral to therapies, for example, is very efficient, then there is less paperwork to do. For example, at my present agency, fo a new, if they alrewady have a PT and HHA eval on the referral, they get there own copies, and we just call them and leave a VM when the case is opened. If it was a SN eval only, and we think they should have PT or HHA or whatever, more paperwork, have to do a interdepartmental referral form. Some agencies have you write up one form for each referral, when we could check them all off, and send copies to each one.

    The last agency I worked at, we had to write up FIVE forms for a HHA referral, then fax all five over ourselves. My present agency, we write up two forms, the secretaries do the rest.

    I don't have any suggestions as to how to get it done faster.

    We had a discussion in the office yesterday. I was discharging someone, and of course, the chart should reflect all the goals selected on the care plan. Well, this pt was a THR, all we saw him for was to 1. assess wound, instruct meds, etc... then we took out the staples. Then my visit was to eval the wound after staple removal, which it would be fine, then DC to PT. Well, the admit nurse checked off every blessed thing on the care plan, so I had a long documentation job, reading the chart first to see what was taught, being sure I covered all the selected teaching, which 50% was new to pt, then write it all up. I c/o people check off everything for no reason. Another nurse in the office said we should check off everything for everyone. I disagreed, I said our job was to assess each pt individually, then check only what applies to the individual, otherwise every single care plan would just be the same! We have to be sure we don't make more work for each other too!

    If you are having physical difficulties, why not ask to cross train as a sub liason, intake, or QA nurse, then when a spot opens up, maybe you could hop in there.

    Anyway, glad you stopped in, hope you post often!

    Linda
  6. by   Taree
    hi!
    i'm a hh nurse and have been for the last two and a half years. i started with a pediatric only agency and have since moved into an agency that does from 0-100... i too cringe at pps and oasis forms. i've gotten good at doing them, but who are we kidding, it's just more paperwork for who knows what reason. i've recently been promoted to clinical director (it was sort of just dropped into my lap) and often have questions about medicare issues that i've tried other avenues to find the answers to and have yet to find them. if there is anyone out there that can help, i'd appreciate it!
  7. by   hoolahan
    Hi Taree,

    The best source for Medicare answers is the HHM 11 (Home Health Manual 11, or the "Hymn 11") You can find the manual here...Medicare Manuals I tried a direct page link, won't work.So, keep clicking on Medicare, and professional technical links, until you get to a page that has a blue link to Medicaid and Medicare Manual, keep following links until you can click on "Pub 11" for the home health regs. I have found it is always best to get the info from the source.

    I also found that it is very helpful to call your local rep and find out if there is any training available, videos, conferences, workshops, etc. You may get additional support from your accreditation agency. I called the state BON also, and they told me to go to these people. Check out my website for more info, link in my signature, and all links are on the first page. Try the homecare association of america. I think the web address is www.aahomecare.org/ you may also want to check out www.vnaa.org. The last two places require membership, if your place subscribes, their bulletins are a huge help.

    Welcome, and post often!!

    Edited for web link errors
  8. by   Taree
    Thank you, that will help a great deal. I've had another question pop up and I'm currently looking for the answer, but thought I'd post here. Is there any precedent for billing Medicaid Holiday and Overtime? We're required by law to pay it, especially the Holiday pay, are we supposed to be able to bill that? Or...no?
  9. by   hoolahan
    Yes, at least in NJ.

    NJ has framed out many pieces of their Medicaid contract. What this means is that the state has taken the budget for a particular area of Medicaid, and signed a contract with a vendor to provide that service for them.

    Ex. The managed care Medicaid program I worked for was contracted by Caid to take on X number of members for X budget of dollars. (The bonus for the managed care co's is that they can regulate how those dollars are spent, hence the need for auth's, etc. This saves the state a lot of money in hiring all those employees to do that. The company must still provide all the services that the original contract had, eg providing transportation to appointments for healthcare, etc... Just that it is closely monitored.)

    Back to the original question. So, Medicaid in NJ, has contracted a company called Unisys (at least this is the vendor I know of, maybe there are more than one vendor??) to do all their BILLING. So, first you must find out the procedure for how to submit a request for services (at least for PCA services that is.) Then, find out where the manual is for the company. Unisys I was told by the extremely helpful nurse in the local Medicaid district office, has a providoer service manual, and even a provider service number I could call for help, and even to set-up a training. So, that is getting to the eventual point. Find out the process, b/c there are special billing codes we use to charge differently for weekend and holiday hours (again, this is in reference to PCA services, not skilled nursing.) I am NOT aware of a code for OT though, you may just have to eat that.

    I have to fill out a form to request auth for PCA services and submit that to the Medicaid District Office (MDO), I have to calc the hours, and fill in the right codes, etc...(found in the Unisys manual), then once they give me auth, and I have signed MD orders back, I can submit to billing, who deals with Unisys, and submitting the claims. They bill for the hours of service provided.

    Well, that was certainly a long-winded answer, hope you're still awake!

    Like I said, go straight to the source. Be polite, and be humble. If they can't help you, They will know who can. Like the nurse at the MDO told me after the 3rd call, you know, you need to talk to Unisys, I said who's that? And she educated me. Today I had to speak with her about another issue, and she helped me again. She is a saint!
  10. by   treefrog
    Hi,
    I've been in homecare since April 2001. My first nursing job was on a vascular surgical unit with some general surgery, and most recently did postpartum nursing in a birthing unit. When the hospital I was working at closed, I decided to make the move to homecare. The idea of autonomy and flexibility really appealed to me, although I was sad to have to give up OB. The past few months have been both amazing and challenging. Some days I have felt so stressed, like all I do is "screw up". Other days, I am able to see the good I do for my patients, and receive praise from my supervisors. There has been so much to learn....I mean, the insurance and case management part is a given, but learning the disease process in many different cases has been a challenge......sometimes I'd go into a home and have no clue what to do with a patient. But my agency is extremely supportive, and has given me all the support I have needed. I would never go back to hospital nursing. The only thing is, I've often missed OB nursing. Well, yesterday I found out, I will now be the agency's second OB nurse (there was one previously, but she needs to cut her hours). As you can imagine, I am thrilled! Now I can do the work I love, in the setting I love! With the flexibility and autonomy I have come to enjoy every bit as much as I knew I would!
    So....just thought I'd pop in and say "hello".......
  11. by   hoolahan
    Welcome treefrog!

    I just quit my home health aide supervisor job, I don't have the energy to explain why at this point. I think I will write an article about the experience though. Anyway, Back to VNA full-time instead of just weekends. I am very excited. The final lure was the promise of working in my own zip code, and half of my own township!!!!! Can it get any better than that????

    Please post often.
  12. by   nur20
    Hollahan , have you jumped ship again!!! I can relate to the pursuit of happiness . I told you i knew where your heart was. Congratulations!!! And i would love to hear your experiences of your supervisor position
  13. by   billssisbeth
    Ta Dah! It's Beth! LOL.
    I have been in HH for 10 + years. I LOVE it.
    I give ONE to ONE care, I am respected, cared for and I go to the "enth Degree" for my clients.
    I Chose Pulmo as my specialty and know a variety of vents, trachs and specialized pt. care.
    I have specialized skills that some "In House Nurses" have stood by in amazement as I handeled situations they would call RT to fix.

    I love my job. I love knowing I am trusted to work in people's homes and having to be independant and self sufficient. Before I got into Home Health I was very afraid of accepting total responsibility for a patient. I used to depend on other nurses to help me accomplish tasks, but Home Health has forced me to become more educated, more multitasked and organized.

    I wouldn't go back to "In House" Nursing for a Million bucks a year!!!

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