Home Health Reimbursement

Traveler · Jan 20, 2005

I have been in hh for 4 years. There is more paperwork in hh than in any other area of nursing. Most patients will be Medicare. When Medicare started with PPS, patients are certified for a period of 60 days. Basically this is how it works. Upon admission an OASIS is done by the RN. From the OASIS, certain items are worth "points". (Dyspnea, pressure ulcers, IV's, tubes, functional status, need for therapy, etc.) Based upon the points in each area, they fall into a category. Based upon your geographic location and if you are rural or urban, there is a fixed reimb. rate for the entire 60 day period. It is very very rare that we do daily wound care. Our IV's are usually with Medicaid or private insurance. They prefer for us to teach the family in around 3 visits how to do IV's. In order to operate an agency, you have to apply for a Certificate of Need in your area. All of the OASIS data is transmitted electronically to the govt. Since PPS, many HH agencies have closed their doors. We went from being able to send a HHA 3/day to max 3/week. With Medicare (Medicaid and private ins. tend to be mroe strict), there has to be a skill- this can be teaching or a procedure. However, VP no longer count as a skill. We used to have lots of hh patients who had monthly PT/INR- we still do that, but it is not a certifying reason. For injections (b12, etc.) we have to document about why patient or c/g can't do it or be taught to do it. There is much to know in hh and appropriate coding is a must. PM me if you have any more questions.

Ann