Difference of the nature of the disease between patients at a home care that uses pap

[50kn]

1. when i went to an interview the interviewer emphasized that "in our home health company, nurses open a case." is there somebody who opens a case other than a nurse at other home health companies?

2. the interviewer said that "we don't use oasis, we only use paper documentation. the main nursing skills that nurses use at our company are wound care, would vac, iv insertion, iv atb, some patients has infection at a central line site, etc." i believe a company uses oasis when their patients are medicare patient. is there any difference of the patients' condition between medicare patient and non-medicare patient who still needs skilled nursing care? is there any difference of the nature of the disease between patients at t home care that uses paper documentation and patients at a home care that uses oasis?

3. if a patient is not medicare patient, who usually pays the medical fee? who decides if the patient is a medicare patient or non-medicare patient, and how?

a lot of question. thanks a lot in advance.

[Susan317]

Hopefully I can answer some of your questions.

1 at some agencies an admission nurse does the start of care oasis and then reports to the case manager, who then follows the patient until discharge. I find that I like to do my own admissions for a few resaons, one being that the patient doesn't have to tell their story over again. And its easier to make a connection with the patient and numerous diagnosis that might be involved.

2 this question is a little confusing,some agencies are on computer some still on paper.either way its still an oasis when medicare is involved,this oasis is the bill your agency sends the government. other types of insurance dont require submission of an oasis document,but the oasis is all encompasing and is the best way to gather information about the patient and have practices remain consistant. this might answer number three also. patients either have medicare or they don't people are elligible for medicare at age 65. younger patients typically have private insurance blue cross or united heath are examples

[50kn]

thank you susan317, your response helped me a lot!!

i have one more question.

the company i went to interview for prn is located very far from my apartment (about 3 hours) but they said that they occasionally have some patients close to my place. i asked them how nurses submit the documentation to the company after they finished a patient visit. the company said that nurses could either fax the document, mail them form a post office, or scan them and send them via internet. are these methods of submitting a documentation normal when the nurses work under a similar situation? (i don’t have a fax machine at home though).

[Susan317]

Yes this sounds normal, if you are able to complete your documentation in a timely manner I would suggest just mailing them. Some nurses wait days before completing the oasis,I like to get it done tomorrow will bring a new set of things to do. Also the agency might not pay you until they have the visit notes in their hand,which might delay your paycheck. Seeing that you are far away, I might suggest finding an agency on computer,files are transfered every time you sync. If you don't mind waiting to get paid, mail should be just fine. There is alot to learn about oasis and being so far away from the office, I would ask about training they will provide.

[AMN74]

1. when i went to an interview the interviewer emphasized that “in our home health company, nurses open a case.” is there somebody who opens a case other than a nurse at other home health companies?

at our home health agency we have start of care nurses. they do the admission, get the necessary paperwork completed, write soc orders, and then turn them over to the regular nurse. this is done for a couple of reasons. the soc oasis is time consuming, they go over the admission paperwork and are more familiar with it, and they cover rights, responsibilities, and do initial skin assessments, home safety assessments, med profile, home health rules and regulations and fall precaution assessments. if the soc nurse is too busy then the field staff are asked to do first visits. at a first visit we have consent form signed, enter meds in med profile and do as much teaching and assessment as needed until the soc nurse can get there 24-48 hours later. we always leave a number to the agency so the patient can call if they have problems or questions.

2. the interviewer said that “we don’t use oasis, we only use paper documentation. the main nursing skills that nurses use at our company are wound care, would vac, iv insertion, iv atb, some patients has infection at a central line site, etc.” i believe a company uses oasis when their patients are medicare patient. is there any difference of the patients’ condition between medicare patient and non-medicare patient who still needs skilled nursing care? is there any difference of the nature of the disease between patients at t home care that uses paper documentation and patients at a home care that uses oasis? if your company accepts medicare or medicare advantage/hmo plans then they are mandated to do an oasis, unless the patient is paying privately for care. it's a government regulation, not something you can just choose not to do. whether done in a computer and entered by someone in your office or you do it on the computer the oasis has to be done.

3. if a patient is not medicare patient, who usually pays the medical fee? who decides if the patient is a medicare patient or non-medicare patient, and how? if the patient is not medicare, they may not require oasis, for example a workers comp patient under the age of 65, or a privately employed person that has private insurance. our company does some "non skilled" medicaid visits that do not require oasis.

a lot of question. thanks a lot in advance. a hope this helps! good luck. home health requires an immense amount of paperwork, regardless of whether you are doing an oasis or a regular visit. remember on patients that require an oasis they have to be done at recert time, when transferred to a hospital, if a death at home, at discharge, upon discharge from the hospital. the oasis generates a score that tells medicare how much money that patient gets per episode and then it is the home health agencies responsibility to manage that amount of money to care for that patient during the certification period.

you mentioned that you can mail, fax, or scan and send paperwork to the office. our office will not allow us to scan/email to the office because of hippa laws. we have to fax all paperwork into the office. the oasis is "time sensitive" also. you have 5 days to have it entered and "locked". if you mail it the day after you complete the visit and it takes a couple days to get to the office and then time to enter all the info into a computer...you may run out of time by using snail mail. our agency is computerized. i don't know how agencies do it that are still on paper. oboma care has mandated that all agencies/dr offices/hospitals/clinics that accept government funding for payment be computerized by 2014 i think... i'm not sure of the date that it's mandated, but it's coming to everyone that accepts medicare/medicaid. our agency went computerized before oasis came out...so it was just a matter of getting used to doing the oasis correctly by the time the oasis was rolled out. computers, while a pia, do give you access to see the patient records. i can see what the social worker said on her visit, what the pt/ot orders are and what they are doing on their visits, if i didn't see that patient before i can look at the last few nursing notes and get a feel for what is going on with the patient. i can see orders, see all meds patient is on, check drug interactions. and if i'm on call and it's a patient i don't know i can pull them up and read about them in the chart.

i hope you enjoy your new job!