Who's charting is it anyway? - page 2

:chair: this is me hiding from my boss. she is always trying to make me rewrite what i have charted. let me state that i am not a new nurse and i have been in homecare for almost 4 yrs. she is very... Read More

  1. by   DutchgirlRN
    Quote from renerian
    if a person is independent with ambulation, stairs, etc, then the admission should have been stopped if Medicare was the pay source realizing the homebound issue was not met
    I respectfully don't agree with you. I've admitted many patients who were ambulatory including stairs and felt their admission was 100% justified. Patients such as these are usually discharged after a couple of weeks. I have worked for an agency that held onto them 60 days and recerted one or more times. That is wrong and I did refuse to do those visits. I've had coders/DON's insist that the patient be considered incontinent, etc...On the flip side I've admitted private insurance patients who desperately needed HH and couldn't get more than 2-3 visits approved for them. There are things wrong with the HH system but by in large HH works well and is valuable service when appropriate.
    Last edit by DutchgirlRN on Jul 18, '07
  2. by   NRSKarenRN
    Patients CAN be independent with stairs and ambulation and still be homebound.

    a. Post hospitalization for surgery when restricted to the home
    b. Fraility: needs assistance family member to leave home
    c. Newly diagnosed IDDM with blood dugar fluctuations: unsafe to
    drive till stabilized.
    d. Alzheimers/Dementia patients: need 24 supervision.


    These are things can think of off top my head.

    Now if they are going to store to pick up meds then drive for haircut or dinner with buddies/lunch with ladies, nope not homebound.
    Last edit by NRSKarenRN on Jul 22, '07
  3. by   DutchgirlRN
    Thank you Karen. I was in a sleepy stupor this morning and couldn't come up with any examples.
  4. by   runrn
    I used to work for an agency that had "team conferences" that consisted of asking every person involved with patients care to give their opinion on the oasis questions. It was a joke...most times the answers were never the same and it would end with the supervisor choosing the answer that would yield the most points on oasis score. When the time came for the R.N. to do the recert, the results of the team conference were given to you as though it were your guiding light. If your answers didn't jive with the ones given to you, then you would get hell. I certainly have nothing against getting input from nursing assistants who know these patients the best, but as far as oasis questions go, I only resort to doing this if I feel the patient isn't being forthcoming, or if I felt I didn't get my point over well enough to get an accurate answer, and if I'm teeter-tottering over two choices. But it has to be my choice, I have to know the assistant well and trust her opinion. I once read somewhere (maybe on here) that the oasis is not a "group effort". I liked it so much I used it one day at work when they irritated me to the point of wanting to hurl my chair at them. They didn't like it, but it beats the heck out of an armrest upside the head. (Kidding, really)
  5. by   runrn
    It beats the heck out of me that nurses would risk their entire career by encouraging fraud within the medicare system. And for what? Most of these nurses are on a typical salary with no special perks. How is it that they take that kind of risk at a time when whistle-blower lawsuits are at an all time high? I think there should be mandatory education on fraud before a nurse enters the home health arena with major point being: If you get convicted of medicare fraud, even if you don't lose your license, you get excluded from the entire program itself. Which means you can't get a job working anywhere that medicare is a payor source. Correct me if I'm wrong here.
  6. by   caliotter3
    runrn

    You need to look at some of the people I used to work with and tell them what you said in this post. I totally agree with you. Sometimes a person has to just burst at the seams keeping their mouth shut or straining to look in the other direction. I have symptoms just from trying to figure out how things are supposed to be. Ducking and dodging other people's behavior is added stress and encountering head in the sand supervisors is a pain. It would be so nice just to be able to go to work and take care of patients the way they're supposed to be taken care of instead of spending a good portion of one's time trying to stay away from somebody else's fraudulent acts.

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