First 2 Certification Periods

[Kabin]

Does your company consider the first 2 certification periods (6 months) to be a freebie? In other words, do patients stay on service for the full 6 months even when the team questions the pt's appropriateness?

[NC29mom, ASN, LPN, RN]

Absolutely not. Regardless of benefit period, if they are not appropriate, they are discharged.....promptly.

That's very shady, and will only raise red flags for auditors. It makes me wonder, why were they ever admitted?

As nurses, we have the responsibility to adhere by the Medicare admission guidelines for appropriateness. Taxpayers depend on us to prevent fraud, and waste in the healthcare system. I can promise, if Medicare audits and the company has to pay money back, they are going to be looking at the nurses first....

[Kabin]

That's good to hear. I'm in full agreement.

[dleechpn]

I agree with the pervious post. Patients are evaluated at each visit for eligibility. If at any time this is in question it is brought to team and if determined that the patient is no longer eligible then the discharge process begins. The patient/family is given a letter of denial which they have 2 days to contest. If they do not contest the patient may be discharged to a safe environment with appropriate care.

[TammyG]

We occasionally discharge in the first six months, if the patient is clearly not eligible. We sometimes discharge in the first month, if it looks like a mistake has been made in admitting the patient. The decision is the MDs, however, and not the RNs or even the IDT, though of course the IDT discusses the situation. But it is important to remember that it is a medical decision.