what qualifies?

  1. I have only been in home health for about 6 months. My company doesn't allow us to see patients just for blood draws (Like protimes) if therapy is no longer involved. I have a patient with polycythemia, and I think that his condition should be monitored by nursing, but my superiors are not giving me the go ahead. Once therapy is finished they will have to get the q month blood draws done somewhere else. Is this something that everyone is experiencing? Is it medicare, or just my company?
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    About kcrnsue

    Joined: Nov '02; Posts: 102; Likes: 5


  3. by   sunnygirl272
    it's medicare. venipuncture alone is not a skilled nursing need.
    you may feel the client needs continuing monitoring...but medicare will not allow payment for monitoring a stable client just in case something ges wrong..even though you know it will go wrong eventually...
  4. by   hoolahan
    Do you guys have quest labs or labcorp in Idaho? In NJ, it is a well-kept secret that they have mobile lab services for homebound clients. You can find this out through your local corporate office.

    If you don't have those lab companies there, call the pt's docs and ask where they send their labs. Call the coporate offices of those labs and explain you need a mobile lab service.

    Usually, they fax a form to the doc, the doc signs the order, and frequency, and faxes back, then they will set it up. I usually allow 2 weeks.

    My agency is getting so stingy they won't provide us w butterflies any more. So, we are making the docs do this more and more often. Now we pretty much will only get the first lab done, then tell the docs, you need to set this up before your next PT/INR is due.

    The only other option if these services are not available in oyur area is for the pt to private pay.

    That is all for Medicare. Sunny is rioght, they will not cover labs unless there is a skilled nursing needs as well. Under Medicare "monitoring" is not a skilled need, under Medicaid it is OK, but not Care. How long has the case been open already? Has there been a recent med change? Unstable vitals? New edema? Can you grasp at any straw here so it looks good to keep open under skilled nursing? Is the pt truly truly homebound, or just is inconveniencing someone to take them to the lab, ie bedbound and needing ambulance vs moves slow and has a hard time finding a ride. Both are still homebound, but for the latter, maybe you could talk to MSW and set-up transporation to the lab?
  5. by   Maerzie

    Medicare doesn't pay for "only venipuncture" SNV's. If you can't document any other skilled need, your teaching the patient the importance of continuing to go to get his venipunctures is about the last skill your office will be reimbursed for.

    Remember, though, teaching is definitely a skill, and if you can document and fulfill teaching needs (and the patient is truly still "homebound",) your manager should agree that the visit is covered.
  6. by   imupallnite
    kcrnsue where in idaho north or south?? me im right in the middle!
  7. by   kcrnsue
    Well, thanks for all the great input! To try to answer some of your questions, he has medicare and va, and he is truly homebound. And also, I live in Beautiful North Idaho! And I dont think we have mobile lab services.
  8. by   nursesearl
    Maybe the VA would come draw his blood. In our area the VA has "home based primary care" which is similar to a CHHA, but do only Vets ofcourse. I had a patient who only needed venipunctures (protimes) and I refered him to this VA home care, and they are now drawing his protimes. We also have a travelling lab service in the local hospital, but they will only go within a certain distance (we live in a rural area).
  9. by   renerian
    Yes it is Medicare. Does not take a nurse to draw blood. I agree with a previous post you can refer to a mobile lab or lots of clients get blood drawn at the drs.

  10. by   CardioTrans
    OK.......... lemme step on my soapbox...... hehehe........ you can thank the Balanced Budget Act of 97........ok look at it this way......... Medicare can pay say $100 bucks a month to the agency..... and 30 to the lab one time a month to keep these drug levels.....blood sugars, anything that we once used to do under control........... now they wont pay for it......... says it doesnt take a nurse to draw a lab....... but now they are having to pay thousands of dollars for a hospital stay for uncontrolled diabetes, seizures, an occurance of a-fib....... because no one knew their meds were not at therapeutic levels........... anyone see whats wrong with that picture?????????

    Ok....... im done........ ehehehehehe
  11. by   Maerzie
    Yes, Cardio-Trans, it seems like the nurses(?) who decide what will get paid and what won't qualify have never really been practicing nurses. And they certainly don't know anything about critical thinking! Lots and lots of degrees, important positions where they can be dangerous, and minimal practical sense!
  12. by   sphinx
    At my agency nurses never do venipuncture to draw labs. We only draw labs from lines. All our labs are set up with a local lab who comes to the home to draw the blood. Whatever their payer is, is billed trhough us while they are on services. When they are D/C because they have no further skilled needs (be it nursing, PT, OT or ST) if they are homebound, we let the MD know that if they need to continue the home draws, the MD office needs to call the lab to set up home draws. At least one other local lab does home draws besides the one we use, maybe a third (but I am not sure about them). If they are on care, we set it up, if not, the doc set it up.
  13. by   Jay-Jay
    Same here. Are you in Canada too?