Discharges and pay???

annaedRN, RN · Apr 5, 2010

It sounds like you have not had a very thorough orientation. There should be someone at your agency that went over all of this with you! Find someone and let them know your concerns and questions!! Anyway, once a transfer has occurred - you do nothing with/for patient until they are discharged home with a referral from the docs for further service. You should be seeing them within 48 hrs to complete your next assessment. If they come home before day 56 you would do a ROC. If during days 56-60 then you would do a ROC as a recert (make sure to write orders for those days that occur before the new cert period) and if they come home after the cert period has ended then it needs to be a SOC. You do not need to discharge them in this case b/c the transfer would be the last OASIS and sufficient. So, unfortunately - there is no pay until they come home. The SOC, ROC and recerts HAVE to be done in person - they cannot be done over the phone. If you have been doing so then you are out of compliance with Medicare regulations.

KateRN1 · Apr 5, 2010

I think the OP is asking how she gets paid for a "non-visit discharge" when she is paid per visit. This is part of the problem that I have working on a pay-per-visit basis, there is so much that is simply not captured in a per-visit rate.

If you are paid per visit, your office should have a rate for "office work" or "coordination of care" or some such that should cover time you spend giving report to other nurses, getting report from LPNs, doing non-visit discharges, etc. Simply ask what form you use to capture that time.

spejsa · Apr 6, 2010

KateRN1 thank you so much!!! This is exactly what I was asking. AnnaedRN, no I did not have an orientation.. I went with one nurse for 2 days in teh field... Worked in the office 2 days and was sent on my own... That is all the orientation I received.. I am doing my best to find my way. Thanks!

spejsa · Apr 6, 2010

I guess I did not realize that I did not need to do a DC as much as I thought I did... Thanks for all of your help!

annaedRN, RN · Apr 6, 2010

Sorry spejsa - read your question wrong! That stinks about your orientation - I orient new nurses and it ranges anywhere from 2 weeks to a month depending on skills and experience before they are entirely on their own...and even then, they can call me whenever they need to. Hopefully things start getting easier for you. OASIS is quite complex and takes quite awhile to get used to.

spejsa · Apr 7, 2010

Well, I am not a new nurse, just new to home health..

KateRN1 · Apr 7, 2010

Home health is a whole 'nother world of nursing, with its own set of guidelines that sometimes make no sense. It will probably take you six months to a year, maybe more, before you really feel like you know what you're doing with the paperwork. And just about the time you think you have it all figured out, CMS changes it. And no one tells you until they do chart audits a month later and then you have to go back and change a whole bunch of stuff. Ugh. It also helps to work for a couple of different agencies, then you have an idea of different ways to do things.

annaedRN, RN · Apr 7, 2010

Does not matter if the new RNs are new to nursing or not...they are with me for that long. Has really helped...we have a very low turnover rate..many nurses have been here 10-20+ years. The more thorough the orientation - the better it seems for new RNs to manage/complete the OASIS as well as the case management aspect.

spejsa · Apr 8, 2010

Thanks you guys! I know it takes a while and I need to give myself time. I just want to feel like I am not in trouble all the time...