Pts need PT/OT only

Specialties Home Health

Published

I have worked for a few different Home Health agencies in the past, I have never encountered this but also cannot find how to support my point. The owner (nonmedical) of our agency insists on at least 5 SN visits for ALL patients even if they have no skilled need for nursing and are clearly for therapy only. Can anyone help where I can find a guideline to support this? I think its a waste of time and money to do these visits. Please help....

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Specializes in jack of all trades.

Per CMS a PT can do the Oasis. Some companies prefer the Nurse do the Oasis to determine the safety of the pt's ability to do PT. Pt then does thier visits and the RN then does the DC Oasis the same day the PT does thier DC visit. Between the RN (2 visits) and PT (at least 3 visits) you have you 5 therefore no fear of a LUPA. At least this is the way we practice.

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Specializes in LTC/hospital, home health (VNA).

Yep - if the only skilled need justified is PT or OT..then that should be all they get. A nurse can open the case/do the OASIS...but that would NOT be a billable visit. If your company is saying 5 visits JUST BECAUSE...then they are most likely committing Medicare fraud. They are trying to prevent a LUPA (less than 5 visits) - in that situation you get paid per visit (less $) rather than for an episode of care (more $). If the PT or OT are making more than 5 visits though -- it wouldnt be a LUPA anyway. You need to find out WHY your agency is requiring 5 nursing visits...because in order for Medicare to pay for them you need to justify the skilled nursing need and homebound status on each visit...not just because they said so.

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Specializes in Functional Medicine, Holistic Nutrition.

I agree with the above poster. It depends on if the agency is billing for all 5 visits and if there is a skilled need for SN or not. If there is not a skilled need and the agency is billing for the SN visit, then this is Medicare fraud and you have the Conditions of Participation to validate that. If the agency is choosing not to bill for the SN visits if there is not a skilled need, then this may just be a difference is agency policy. Some agencies prefer the SN to do the opening and discharge. The 5 visits required by an SN is a little odd though. You can't require 5 visits- there has to be a skilled need and the pt has to meet homebound status.

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Specializes in COS-C, Risk Management.

I concur with all of the above. If there is no skilled need and it's the policy of your office to have RNs complete OASIS assessments, those RN visits for therapy-only cases are non-billable and have no impact on LUPA status.

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Specializes in jack of all trades.

Just to clarify, we dont bill for the RN to do the Oasis - but do for the PT to go in the same day and also to the PT to d/c the Same day. Believe me we avoid that big F word as much as anyone possibly can. I cant tell you how many oasis I kick back every day to the field nurses. Especially when you find one stating pt can walk 250ft without assist, then why the heck PT in? or the "On arrival pt washing his sidewalk!" Jeez, can say it over and over but sometimes just doesnt get through lol. My office has really cracked down hard on documentation and communication between the disciplines. It's getting better but still a bit to go. We've started kicking in contest for the least oasis errors or turning in daily pw on time, etc. Small gift certificates but at least they know we are trying to show some appreciation. Boss took us all out for nice steak dinners last week after work and we made a point "no work discussions" during that time. We are required to read every pt/ot note and question them at anytime. If an issue then we write it off and delete the charge. Forturnately I'm in an office that does pay attention.

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