Homebound but working?

caliotter3 · Aug 26, 2009

If you don't want to work on that case, then tell them that you do not want to be assigned to that case. Make up an excuse if you have to. Remember, in home health the key word is "flexibility".

berube · Aug 26, 2009

i think first it depends on the payor source, tho i do not agree with it, some payors say the patient does not need to be homebound,,,,also i did not think that labs was considered a skill anymore,,,but it may come down to the payor source.

HHLVN · Aug 27, 2009

Sorry, I forgot to make myself clear! The patient is Medicare! I know most insurances will allow home health if needed and the patient can still go to work. But under MC I have never had nor heard of seeing a patient that is able to go to work, even if they are disabled. Taxing effort doesn't apply for this. If it did we would all be homebound! Luckily I didn't have to see him today, couldn't contact him. But, unless I'm wrong, isn't this fraud? And, no, MC doesn't pay for any type of labs, in or out of the home.

GrumpyRN63, ADN, RN · Aug 27, 2009

I think whoever drives him to work should swing him by his lab and have them draw his labs or his md should order him his own INR meter so he could do it himself, we don't do any blooddraws period, wouldn't be an issue for me, but I agree, he's not ( anywhere near) homebound, I wouldn't want to be involved with that case

ellakate · Aug 27, 2009

But, unless I'm wrong, isn't this fraud? And, no, MC doesn't pay for any type of labs, in or out of the home.

Yes, it is fraud.

berube · Aug 28, 2009

i agree, i have read and re-read this post------MEDICARE FRAUD!!!!

KateRN1 · Aug 29, 2009

I'd agree with the fraud aspect due to not being homebound, but not with the labs per se. If you have a patient on anticoagulant therapy, your skill should be teaching the patient about the therapy. You also have a three-week window for skilled assesment based on acute changes, assuming that the anticoag therapy is new. If your DoN cannot give you an adequate explanation for "overlooking" the homebound guidelines, then I'd say you should be looking for another company. (Some Medicare HMOs do not require homebound status, only an acute change in condition.)

HHLVN · Aug 30, 2009

Thank you all for your thoughts. The pt's been on service since Feb this year, not an HMO, straight MC. Yes, I agree, it's definitely fraud and I just can't believe how obvious it is! I have already decided to find another agency ASAP. This is just some of the icing on the cake, too much to go into here. Just trying to decide when to notify MC of all the problems with them. Guess I will after I leave.

caliotter3 · Aug 30, 2009

Best to do it after you leave. Hopefully by then you will have received positive or neutral references from these people to help you get a new job.

HHLVN · Aug 30, 2009

That's what I figured, too. Plus I think I'm the only one there who hasn't actually seen this pt. The other nurses there act like it's no big deal that he works. Not sure what background they have for HH but don't think they understand the rules. Can't wait to get out of there!

caliotter3 · Aug 30, 2009

As you look for new employment be careful about bad mouthing these people. You have no idea who is friends with who and who will look down on any indication from you that you were dissatisfied. Also, employers would be afraid that you are a do gooder who might be inclined to turn them in for their misdeeds. Just be careful.