General home health questions

[tinybbynurse]

Being new to this area I have a few general questions for those of you who deal with Medicare patients / OASIS charting. The old DON and other RN left recently and it’s a small company - and my supervisor isn’t an RN and has some answers but not all.

1. Say a patient doesn’t need skilled nursing services anymore, but could benefit from continued physical therapy, at time of recertification, can I discharge the patient from skilled nursing but recertify her for physical therapy only? Or would it not require a discharge at all, but simply a recert only including PT visits?

2. Are you allowed to discharge a patient BEFORE the end of their next recertification period? (I’m pretty sure I heard yes...)

Thanks!!

[Nurse on the Go]

Hi tinybbynurse!

In answer to your questions:

1. Nursing would do a discipline discharge (not an OASIS discharge, just a discharge from nursing services) and PT would do the OASIS recert within the patient's 5-day window.

2. Yes, most of the time it's fine to discharge before the end of the cert period. Often the patients will meet their goals prior to the end of the cert period and/or may not meet the requirements for ongoing care and are appropriate for discharge.

The COPs (conditions of participation) outline 6 situations when an agency can discharge a patient. They are:

• If the patient has met his/her goals
• If the agency cannot meet the patient's needs
• If the patient or payer will no longer pay for home health (this also applies if the patient is no longer homebound and therefore doesn't qualify)
• If the patient refuses further services
• And if the patient dies or the agency closes (obviously!) ?

Hope that helps!

-