Doctors denying admission or recertification?

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I'm trying to figure out for what reason a PCP would refuse recertification for a patient. I saw a patient today who desires home-health, has a truly taxing effort needed to leave the home, has skill that we can prove to Medicare, but the doctor insisted on discharge. I just wondered what the incentive for him to refuse recertification might be? Wondered if there is a piece to the puzzle I'm missing?

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Maybe the doctor does not like this patient or otherwise has an axe to grind. Undoubtedly, you are missing a major piece to the puzzle. Too bad you can't get a frank response from the doctor.

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Specializes in Home Health, OASIS Review, Home Infusion, Wounds,.

I agree, there are def pieces missing, but in my experience there could be a number of things going on where

  • the doctor is making an attempt to right a wrong(s) with Medicare/Medicaid for previous abuse/misuse issues,
  • there maybe something weird going on with the relationship between your agency and the doctor,
  • like caliotter3 mentioned there is something weird going on between the doctor and the patient and the doctor. or
  • the doctor doesn't think that the patient will benefit from a recert and will only get discharged before the HH services are advantageous for the patient anyway.

I hope this helps a little. Feel free to message me with any questions or clarification. Goodluck ?

Remember, We RN this together

Trischana

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