casemangers: do you call the md every recert?

[kembers]

i just got a job with a home health agency as an rn case manager and i've gotten minimal training. at the end of my assessments after you go over teaching it will ask if you had a conference with the md and if so any new orders.. (usually to keep PT OT HHA going) looking at everyone elses previous assessments it seems they all said yes and the new order is to continue therapy or OK to discharge, just general depending on the assessment.. but doing 4 or 5 patients a day I cant imagine any md wants to be bothered with this kind of order... so i dont know if they actually call or if the 60 day conference gets faxed and that was the md getting notified.. im just wondering what other people do basically.

[loveu123]

You will get a better answer if you post your question in the home health forum. The case management forum is mainly discharge planners, insurance case managers and workman comp CMs.

[TheCommuter, BSN, RN]

Moved to the Home Health forum.

[caliotter3]

While I do not work in this capacity, if I were to hazard a guess, the recert paperwork is faxed to the MD office and they just sign it. I remember one MD who actually read what was written and would line through and make changes before adding her signature. Maybe somebody who actually does this will add to the conversation.

[msteeleart]

A lot of the time when I call doctors for anything, they never call me back. The 485 is faxed to the doctor so they will know what is going when they sign the 485.

[Libby1987]

It depends.

A patient who's been on service for years for a monthly catheter change? Probably not, unless there's a change in condition and/or need for change in treatment. In those cases, a fax'd interim is sent before visits in the next cert period occur.

In the cases such as of an unhealed wound, not yet stabilized medical condition, or a need for continued education due to new caregiver or recent new/changed condition/treatment, then yes, communication to the MD/provider is made for approval or confirmation, whichever is most appropriate.

[Haddoa]

It all depends. The Pts who have been on services forever, no. Newer pt yes. Also some docs want to be called with every little thing, some just say hey fax me with stuff like this thanks.

[Sue Damonas, BSN]

I ever called the MD for any recert. They don't want bothered. Faxing the cert over is enough

[oceanblue52]

I was always required to call for MD orders, even if it was just to leave a message requesting an order. At least with my job, you had to document who you spoke with and date/time. Typically you will reach an MA or RN, who will either give a verbal order on the spot or call back with one. I suppose it is somewhat redundant with the 485 going out...but given that you are not really supposed to do any extra visits in a new period withou an order, and the amount of time it takes to get an order faxed back, just makes sense to cover yourself and at least make the call. Can sympathize though with the number of times you feel dumb for calling about dumb things, like holding a cardiac med for dizziness. Lots of things I loved about home health but chasing down orders over the phone is not one of them.

[Neats, BSN]

Working as a Pre-Service RN reviewer I can tell you if you do not have that orders signed by the physician with current office visit notes it will be denied as insufficient information.

[KelRN215, BSN, RN]

It depends. When I worked home health, the bulk of my patients were pediatric oncology. A child with ALL is on treatment for 2 years and we know that their needs are consistent. So there was no need to call the clinic to say "we're going to recert this patient" when the clinic was sending us new orders q 3 weeks and the child wasn't done with treatment yet. Most of the time when I discussed continuing vs discontinuing service with the MD it was a child with, shall we say, social issues. We would get patients referred for non-compliance issues and they would ask for a visiting nurse to see the child to assess family's ability to care for them. I once had a patient who was referred for NG teaching. Usually extremely straightforward. 1 visit, 2 or 3 max. This child remained in the hospital to have a G-tube placed because her Mom couldn't grasp the NG teaching. I followed this child for 2 years- she was still on service when I left the company. There were major issues with her Mom's ability to care for her and she ended up getting taken into state custody after a visit where I discovered that the family had diluted her valium. For her, I was in touch with her doctor (and social workers) sometimes multiple times per work.

[Libby1987]

Working as a Pre-Service RN reviewer I can tell you if you do not have that orders signed by the physician with current office visit notes it will be denied as insufficient information.

Are you referring to SOC orders and face to face documentation?