I am in desperate need of help. I have started being a home health nurse and I love the job but I'm learning that I need a chart patient is homebound due to what I don't understand why that is important and also I keep asking what art skills that are covered through home health so I can make sure I'm charting appropriately does anybody have any help out there so I can be charting affectively to make sure that my patient has continued Medicare services and is not denies payment any thoughts are appreciate . List of non skills would be great Also
Typical reasons I chart for patients being homebound is needing assist of one and assistive devices for ambulation, visually or cognitively impaired, elevation of legs required for wound healing, severe dyspnea on exertion. Acceptable nursing skills for Medicare that I use frequently are neuro assessments, wound care/assessment, administration of injectable medications (B12 shots, routine testosterone injections), assessment and teaching r/t unstable blood sugars, anticoagulation therapy, newly ordered medications, CHF, COPD.
How do you know if somethining you are tteaching on is not a skill requirements ?
Medicare says if someone who is not a nurse can provide this care effectively and safely, then it is not covered. It is reasonable to say a nurse is needed to intermittently change out a foley cath safely, but it is not reasonable to say a nurse is needed to change a daily dressing with say bacitracin and a bandaid. We are usually covered by having multiple skills for each person we take on for homecare, so that even if some of the education or care we are providing is not necessarily skilled there is still plenty in the care plan that is. I am still learning myself, there is a lot of new information to pick up in homecare! I look forward to seeing any resources anyone else has to add.
Are you an RN/LPN? I am getting the feeling that perhaps you have a different role/background and this is where the confusion is.
Medicare will not pay for home health services unless the patient is homebound. This doesn't mean that the patient cannot ever leave the home but that it has to be a taxing effort for them to leave.
I work in HH. It's probably slightly different for every agency. Mine wants us to make sure our patients are home bound usually for a few different reasons: severe SOB with ambulation, need for assistive devices, difficult time getting out of the house (for various reasons), etc. Basically, if your patient hardly ever leaves the house and has medical problems, with limited resources, they're home bound.
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