Doctor order for increasing frequency

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Doctors writing frequency orders per family request.

Situation: pt has been on Home Health services for 4 weeks, initial frequency for 3W3 is scheduled to change to 2W3 next week. The caregiver (wife) in the home wants the nurse to continue coming 3 times a week, she initially insisted on daily visits for 3 to 4 months. The pts SKILLED NEED FOR NURSING has not changed, the pt has been stable with no ER visits, falls or changes in medication regimen. The wife is basically telling the doctor that it makes HER feel better for someone to come 3 days a week to "check" on the patient since the patient has a history of CVA's. The doctor writes the order and faxes it to the office. I have requested a time frame for the 3 times a week and a reasonable and necessary skilled service. I have not yet had a response. Please help me understand if I am still on the right path. It is my understanding that welfare and reassurance visits are NOT a skilled need.

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I am also interested in this question. Seems like the doctor should be aware of the requirements for proper reimbursement and not so willing to just go along with the family requests when they don't meet those requirements.

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Specializes in ER, L&D, ICU, LTC, HH.

Situation: pt has been on Home Health services for 4 weeks, initial frequency for 3W3 is scheduled to change to 2W3 next week. The caregiver (wife) in the home wants the nurse to continue coming 3 times a week, she initially insisted on daily visits for 3 to 4 months. The pts SKILLED NEED FOR NURSING has not changed, the pt has been stable with no ER visits, falls or changes in medication regimen. The wife is basically telling the doctor that it makes HER feel better for someone to come 3 days a week to "check" on the patient since the patient has a history of CVA's. The doctor writes the order and faxes it to the office. I have requested a time frame for the 3 times a week and a reasonable and necessary skilled service. I have not yet had a response. Please help me understand if I am still on the right path. It is my understanding that welfare and reassurance visits are NOT a skilled need.

What did you use for a skill for billing? I don't think just family request or MD order is enough. Anyone else know?

~Willow

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Specializes in COS-C, Risk Management.

You must have a skilled need for each and every visit. If the patient is so unstable that he requires frequent assessment to discover minute changes that could impact his health (hx of flash pulmonary edema, for example), then I could see it. However, the situation you describe doesn't seem to meet that. In my experience, most physicians have no idea what constitutes a "skilled need," and their order does not trump Medicare guidelines. This is definitely a case that needs to have direct conversation with the physician or office nurse (if there is an actual nurse in the office) and definitely time to involve the DON and/or administrator. If you have a marketer/liason who can talk to the doc, that would be another good route to go. Has the initial 485 been signed? Is the doctor aware of the patient's condition? Is there a possibility that the nurse has missed something? How about a social worker for community resources and other elder-service agencies? What is the initial need for home health?

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Thank you!! Does anyone know where I might find documentation of Dr's orders do NOT trump Medicare guidelines? I get these reactions like I am making a cardinal sin if I dare mention not doing what the Dr writes. I would like to do some "Dr Ed" but have to be prepared..

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Specializes in COS-C, Risk Management.

The Medicare Benefit Manual, Chapter 7.

100-02

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thank you!!

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