No longer homebound

  1. Today, I had a very difficult day, unexpectedly I had to stay and monitor one patient and report to the doctor and I knew I wouldn't be able to see all of my patients.
    I called my office and requested that we move one of them ( a discharge) to tomorrow. I called the patient to let him know the schedule change and he stated he wouldn't be home tomorrow, then he told me he wasn't homebound. He said he had notified my office yesterday and he was already driving himself around town. I called my office and repeated what he had told me and it was confirmed the office knew. I then said that we could discharge him by telephone, but met with major resistance. I was told that I had to make the visit today and then I could discharge him. They said if I didn't do this it would effect "our payment."
    My understanding has always been if a patient is no longer homebound then they are to be discharged immediately.
    Does anyone know differently?
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  2. 6 Comments

  3. by   caliotter3
    I think the agency is insisting that you see the patient today to discharge him because they want to avoid some liability issue. Apparently someone at the agency has already done the discharge paperwork reflecting today's date and they have no desire to change this. They want you to complete the visit in order to make their paperwork official. Since they knew of the patient's status previously, really they should have sent someone out the day they found out. Just trying to squeeze another day of payment out of the case.
  4. by   luvdaisy
    Was this last visit going to be the 5th visit? I just recently quit home health and this is one issue that drove me crazy. No matter what, we were pushed to get 5 visits so we would be paid the full amount from Medicare.
  5. by   HmarieD
    One of two things is going on - either your manager has a poor understanding of home health or they are trying to game the system.

    You absolutely can discharge this pt by phone. The only time that not doing a visit would impact payment is if it's going to be the 5th visit so the agency avoids a LUPA. However, if the patient is no longer homebound, the visit wouldn't be billable so if they're honest it still wouldn't matter. Home Health is paid a lump sum for the 60 day episode regardless of # of visits, unless you make four visits or fewer.

    The only real disadvantage to doing this is that it can negatively affect your outcomes. The OASIS will have to be completed by the last OASIS qualified clinician to have seen the pt, and info must be based on the pt's condition at the time of that visit. In some cases, that might go all the way back to the SOC, if the pt has only been seen by LPN's, PTA's, or other clinician's not qualified to complete OASIS. Therefore, no improvements.
  6. by   AnnemRN
    Quote from HmarieD
    One of two things is going on - either your manager has a poor understanding of home health or they are trying to game the system.

    You absolutely can discharge this pt by phone. The only time that not doing a visit would impact payment is if it's going to be the 5th visit so the agency avoids a LUPA. However, if the patient is no longer homebound, the visit wouldn't be billable so if they're honest it still wouldn't matter. Home Health is paid a lump sum for the 60 day episode regardless of # of visits, unless you make four visits or fewer.

    The only real disadvantage to doing this is that it can negatively affect your outcomes. The OASIS will have to be completed by the last OASIS qualified clinician to have seen the pt, and info must be based on the pt's condition at the time of that visit. In some cases, that might go all the way back to the SOC, if the pt has only been seen by LPN's, PTA's, or other clinician's not qualified to complete OASIS. Therefore, no improvements.
    I asked if the patient had received 5 visits, but didn't get an answer. I asked them if they were concerned about a LUPA, and was told that LUPA's
    are no longer being utilized with the new Medicare changes.

    The thing is the patient had improved and he was seen only by nurses. Last week's visit was done by an RN so, if he wasn't a LUPA I don't know what the problem was.
  7. by   HmarieD
    LUPA's are still being utilized. Your manager either needs a Home Health 101 class or they are trying to manipulate their staff into doing something fraudulent without your knowledge.
  8. by   AnnemRN
    Quote from HmarieD
    LUPA's are still being utilized. Your manager either needs a Home Health 101 class or they are trying to manipulate their staff into doing something fraudulent without your knowledge.

    That's what I thought too. The more I questioned the quieter they got.

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