Quote from spejsa
Does anybody have any information regarding what Medicare considers skilled visits?? Our agency has said a lot about the nursing needing to have a skilled need if in a home.. But, I always get referrals that the office sends me to do and it goes like this... Today, I had one that I got yesterday. The woman was DC'd from the hospital. She had a diagnosis of possible cholecystitis. She had been in the hospital and the paperwork indicates that they last did labs on her a few days ago.. The referral states that we were to admit to do a lab that needed to be sent to the Dr. prior to an appt this coming Friday. It is for Amylase, Lipase, CBC, and CMP. I called and spoke with her nephew who states that she is doing ok and this was all that she would need done as she lives in an assisted living center that has CNA's and an RN that oversee her care. He said she is very well taken care of. So, basically, if I go out they will probably not need me to go out and see her all the time... The agency says we have to have 5 visits in a cert. period... It may not happen if there is nothign to teach (the patient has Alzheimer's and I have found most of the nurses in these situations are not teachable...). So, do I go out and do blood draw and then schedule no further visits??? She has Dementia, Depression, and HTN... She is in her 80's. Just needing advice.
ALF patients are difficult to skill. Any patient with memory loss should not sign the consent unless someone else is there to sign as a cosignature.
You can't skill the visit unless you teach the patient or caregiver, and most of the caregivers will not come to the ALF to meet with you and the staff that work there are variable in responsibility.
If your agency is sending you to see patients to draw blood, the visit is not billable. If the agency is doing this alot, or sending you to see patients who can not retain information with no caregiver present, then the agency will be subject to RAC financial reversals or ADR financial reversals at some point in the future.
If the family states they need nothing but a lab draw then document it, calmly report it to your supervisor, and document that. Don't make any waves. Keep a copy of the documentation in a safe place.
Personally, with this type of agency, I would quietly look for another job. Agencies that operate like this are closing left and right in my area and they are a dime a dozen.
It will catch up with them eventually.
Hope this helps.