Minimum length of time for routine visits

[paddler]

I realize different agencies may have different requirements for minimum length of visits. My prior agency required 30 minutes, which is reasonable since most visits take at least this long anyway. My current agency requires 45. Now, considering I get paid per visit, it concerns me that I MUST stay and twiddle my thumbs in some cases for what I see as an occasionally unnecessary 15 extra minutes. While, in other cases I may stay 90 minutes and not get any more compensation for the extra time spent that was necessary. Not to mention the nurses' pay is getting decreased after the first of the year by this agency, and I feel I have every right to say "You pay me 15% less, I will spend 15% less time with the patients when I am able to do so."

My employer claims that Medicare REQUIRES a visit length to be 45 minutes long. And I know for a fact that CMS does not, otherwise why would my previous employer claim that Medicare "requires" 30 minutes. What I would like to find out is if CMS has somewhere in it's regulations the minimum required time for a routine visit, if they have one at all. I searched the CMS website and could not find anything pertaining to a visit length requirement, only that visits are billed by 15 minute increments. I need to find something in writing.

Thanks for your help!

[mcarthur]

Medicare documentation is done in 15 minute increments and the total tallied. Say you are a resp therapist and you document x number of minutes , it is rounded out in 15 minute segments for the total. Maybe what your agency means is that you need to stay for the 45 minutes to account for the nursing care the individual needs for the agencies reimbursement....there is also the possibility and you hate to think it....that they are squeezing medicare for extra time/reimbursement.

[paddler]

I see what you're saying. But, the company gets reimbursed the same whether I see the pt for 30 min or 4 hours, and so do I. Put simply, Medicare reimburses HH on a flat rate (independent of clinician hours spent with pt) and it is up to the company and nurses, therapists etc to divy up the visits so the company still gets paid and doesn't lose money on the case. Therefore I don't understand why the minimum visit length requirement.

[Isabelle49]

I've heard that 30 minutes is minimum. My visits are never less than that, except in the case that the patient is rushing for some reason and I document it when that happens.

There is an agency that certifies home health agencies as being 'great' and I understand that 30 minute visits are not long enough to maintain the certification. Kind of like a joint commission for hospitals.

[homehealth_rn]

We had a meeting last week and our director basically told us that we need to be spending more time in the home because of how it looks when we bill. She said that we need to spend more than 30 minutes in the home, but she didn't say it was a rule. She also said that she doesn't want to see anyone charting in the office because we need to be doing our charting in the home. It seems almost fraudulent to me to spend extra time in the home when I'm not doing anything and just sitting there to run the time up.

[KateRN1]

It seems almost fraudulent to me to spend extra time in the home when I'm not doing anything and just sitting there to run the time up.

Documentation is part of your visit and should always be done in the home whenever possible.

Rather than being overly concerned about the amount of time you spend, concentrate on covering what is on the patient's plan of care, what interventions have been implemented, what are remaining, what has been taught, whether goals have been achieved, and if patient is prepared for discharge. Do this, document this, and you will find that you don't need to worry about your visit length.

[RNMom2010]

We are not given a specific time we are allowed in the home. A "quick" basic routine visit takes me 30 min with assessment and documentation. Sometimes more education is required, phone calls to dr's, dressing changes and those visits can run me up to 1hr 10 min at the longest. It seems to even out all in all.