Medicare rules seem to be killing our agency

[I<3H2O, BSN, RN]

I work at a small but corporately owned agency in a relatively small town. Last year, there was the Jimmo Vs. Sebelius ruling that was passed down from corporate saying that we could keep patients for ongoing assessments for disease processes such as CHF, HTN, COPD, DM, etc. Dx that need ongoing assessments to keep pts out of the hospital. We are currently experiencing some RAC audits company wide and they are now telling us we can no longer keep a patient longer than 3 episodes unless there is a glaringly obvious skilled need. Assessment and teaching is no longer "enough". We are no longer allowed to have patients on service for injections (only) and there is talk of dismissing patients who need catheter care. We have such a small agency and I think it shrunk 30% this week due to these "new rules" or new interpretations of the same rules. What is your agency rule about who to keep and who to dismiss?

Also under the heading of Medicare, how does your agency handle face to face documentaion? We are currently having a major push back from our physicians because they do not fill them out correctly. We have some doctors that say our agency is the only one that requires them to fill it out, saying that other agencies fill it out and just send it to the physician for signature. I'm under the impression (although I have not done any research myself) that it is Medicare fraud to complete the F2F for the physician although the staff in the physician's office can complete it for the physician. Any advice on this topic?

[Isabelle49]

Regarding the agency filling out the face to face, I would think the MD or his office has to denote the date of face to face on the form and doc must sign it.