How to document SN visit frequency

You should NEVER use a zero frequency. I would look at that last week and see how many visits you need and word it accordingly. Are you going to recert the person or are you closing them? Billers aren't exactly the best people to ask about when wording your orders...

Chopper

Thank you for responding. What if there are no visits in the last week? It is the end of the cert period with just 1 or 2 days remaining in that last week, for example Sunday and Monday with no visits scheduled because you have your nine weeks already.

if i'm understanding you correctly, you wouldn't need to write any frequency for those 10 days left. I am assuming, for instance, that maybe you had 1W9, and so the recert was done sometime between thurs and sat, with sun and mon left over (really on what looks like the 10th week). If you need no visit for those 2 days, then you wouldn't have to write anything...the new frequency would be on the recert....so maybe it was 1W9 again...and you could go after monday if that was the last day of the episode. If for some reason you needed to make a visit on that sun or mon, it would be 1D1.

Thank You, it makes perfect sense to me. That way there is no chance for error.

A lot depends on your surveyors -- surveyors in Texas (San Antonio, anyway) instruct to use 0 as a "placeholder". Illogical to me, but I've had them insist that all weeks in the episode are included -- therefore, there are instances, (particularly at the beginning of an episode, say on Friday or Saturday when a visit was made earlier in the week, in the old episode), where 0 is used to account for the week in the episode. Hope I didn't confuse the issue....... Jeanne

If the Surveyors in San Antonio require the 0 placement, then the ones out of Beaumont, Texas do also. I agree that it is very confusing and I don't see the need for it since the objective is to list the frequency of the actual visits being made by the nurse. I appreciate the information because we are expecting state any day now for our annual inspection.

Wouldn't it be lovely if all state surveyors simply followed the Medicare guidelines and didn't lend their own interpretations to determine "findings"? Tinker, good luck on your survey -- We've been expecting ours since December........ running just a tad late! Jeanne

There is a lot of info out there to support not using a zero frequency, and you could certainly justify the argument against them to a surveyor. It just doesn't make any sense. I know in all the teleconferences I have listened to and material I have read...NO "0" frequencies.

Chopper

There is a lot of info out there to support not using a zero frequency, and you could certainly justify the argument against them to a surveyor. It just doesn't make any sense. I know in all the teleconferences I have listened to and material I have read...NO "0" frequencies.

Chopper

I don't think the zero frequency is a bad idea. Like everyone says, it's a place holder sort of. If I didn't have a calender in front of me and the first week of the new cert started on a thurs or fri and I wasn't supposed to go, 0W1, 1W8 would be helpful to me, so that I know, my first visit of that new cert will not fall on that thurs, fri, or sat. Just out of curiosity, how do you all right it so that the person going on the visit doesn't go then, but instead starts on the next week? I know this issue is probably an issue mostly on recerts on the first week rather than new admits.

Kathryn

I think your wording would also depend on if you are using a Medicare week or a calendar week. In our agency, we use a calendar week. If the recert were to start mid week and say the order is for RN 1 x wk you can argue that you did have a calendar week visit even if it wasn't in the new cert period. If you use the Medicare week it may not be an issue. I just think that a "0" frequency is setting up a agency for trouble, especially if you are using a range (ie. 0-2 x wk) as you would have to argue that you are trying to meet the needs of the patient not the needs of the agency...I do understand your argument however! :)

We never use 0 freq. If we have a cert period beginning on a weekend, and the first visit that we are doing is the next week.... we write something to the effect of 1w_, freq to begin week of ______.