Discharge of hospitalized patients

[nurse955]

I need assistance settling an argument with a colleague of mine regarding discharge of agency patients.

The agency that she works for typically discharge patients after 7days in the hospital. Once discharge from the hospital, home care is resumed but a new physician order is not required if it is within 30days.

Please correct me if I'm wrong but I don't remember reading anything in the medicare manual about how many days must elapsed before a patient is discharge.

Is there a specific medicare guideline or is it up to individual home care agency policy?

[KateRN1]

The agency completes RFA 06, transfer to inpatient facility (without discharge from agency) if the patient goes to an inpatient facility. If the episode expires while the patient is hospitalized, then the patient is discharged from the agency using whatever the agency deems the policy (we just end the episode with a discharge date in our computer system).

When the patient comes out of the inpatient facility, resumption of care orders are *required* regardless of how long the patient was in the hospital. Once the patient is in the hospital, all previous home care orders are invalid.

If the agency discharges the patient in the middle of an episode and then the patient comes back, it can lead to a PEP (partial episode payment), which everyone wants to avoid.

[tabster224]

I have worked for 3 different agencies. Those 3 agencies have done a transfer to inpatient facility without discharge (Oasis transfer). If they come out of the hospital before the end of episode, then they do resumption of care. If the patient is still in the hospital at the end of the episode, because there was already a Oasis done (the transfer), then we just do a 1 page short discharge (non Oasis). If they come out of the hospital after that discharge and need home health services, it is a all new SOC.