Lengthy visits

caliotter3 · Jan 22, 2010

Well, you can tell them that you are allotted so much time to spend with them and ask if they have any questions or ideas about how to use the time wisely. However, I bet you a paycheck that they tell you to go ahead and leave and put down the full amount of time on your paperwork. Just tell them that you are going to sit there quietly and work on your paperwork and do just that. Finished with their visit paperwork? Then work on other paperwork. Or you can find some kind of teaching to do. If no topics, come up with one. Talk about a news item having to do with health. Look up their diagnoses on the internet and find something to discuss, then put it down for teaching.

annaedRN, RN · Jan 22, 2010

I have alot of OASIS and complicated visits, but when I have the simple quick CV checks of wound packings - especially those we see each day or aren't talkative...I don't worry if it's a 20-30 min visit. If you did your assessment and provided the necessary care...and the patient is satisfied with your service - that is all that matters. I used to feel a little bad, but now I appreciate the occasional break. Unless your agency has a strict "atleast 30 min" policy, I wouldn't sweat it

KateRN1 · Jan 22, 2010

Medicare has a 30 minute policy. A visit is not billable to Medicare unless the length is at least 30 minutes and a skill was involved, be it wound care, teaching, whatever. Assessment itself without teaching is not generally considered a skill. Is the patient knowledgable on all his/her meds? Does s/he understand side effects and possible interactions? Does s/he know when the call the doctor for symptoms r/t chronic disease process? Do you talk about what you're looking for with the assessment? ("Your blood pressure is good and your lungs are clear, but your ankles are a little swollen. Let me tell you why that worries me.")

I can honestly say that I have never had a 30 minute visit, even with my "easiest" of patients and have no idea how nurses can do a 30 minute visit and do all the things that are required.

annaedRN, RN · Jan 23, 2010

KateRN1 - I was not aware of any Medicare policy that states that -interesting to know. Can I find that in the COP? I do not usually have problems meeting that requirement....but sometimes a daily wound packing of a "appy" gone wrong with no other comorbidities...and the pt is not talkative - can be difficult to go past 25 min or so. Doesnt happen often- but does happen at times. Thanks

KateRN1 · Jan 23, 2010

To be perfectly honest, I've looked nut can't find an actual ruling on it in any of HHA manuals, they are so very freakin' vague, but I'm gonna keep looking. Every HHA I've ever worked for has had that rule in the handbook and from what I've seen, visits less than 30 minutes tend to be denied for payment. Look at it from a Medicare reviewer standpoint, if you're only in there for 20 minutes, what is your skill? I cannot imagine doing vitals, a full assessment, wound care, and documentation all in less than half an hour.

annaedRN, RN · Jan 23, 2010

I looked around too - on the CMS sites, etc. I found something about billing in 15 min increments..that was all. I agree that most visits - in order to do a complete assessment that 30 min is a minimum...I love days where even 2 of my visits are 30 minutes. But I have had a few that because of all the previous mentioned "stuff" have been at the 25 min mark..never less than that. I guess with those "special" few- will need to move slower in order to get it to 30 min. Still want to see the regs though - have a few nurses that seem to have pretty brief visits routinely. Makes you wonder how some agencies can expect nurses to do 9-10+ visits a day when you include all the travel time and calls/supplies/office stuff? Thankfully mine doesn't.

jnette, ASN, EMT-I · Jan 23, 2010

Medicare has a 30 minute policy. A visit is not billable to Medicare unless the length is at least 30 minutes and a skill was involved, be it wound care, teaching, whatever. Assessment itself without teaching is not generally considered a skill. Is the patient knowledgable on all his/her meds? Does s/he understand side effects and possible interactions? Does s/he know when the call the doctor for symptoms r/t chronic disease process? Do you talk about what you're looking for with the assessment? ("Your blood pressure is good and your lungs are clear, but your ankles are a little swollen. Let me tell you why that worries me.")
I can honestly say that I have never had a 30 minute visit, even with my "easiest" of patients and have no idea how nurses can do a 30 minute visit and do all the things that are required.

I agree. Great reply! :up:

There is always SOMETHING to teach on. That in itself will eat up the minutes on the clock. Even if you do a review of what you might have taught on before.

tencat · Jan 23, 2010

Hmmm....not every patient is going to take 30 minutes. I have one who is really hard of hearing, very stable, and refuses to take suggested medications, and refuses to listen to teaching (gets really upset because he can't hear and doesn't understand what's being said). So.....I don't spend 30 minutes with him. I do stay at the residence in my car and do paperwork for the whole time, but there is no way I could spend 30 minutes in that house because we would be having a staring contest or a shouting match with him and his wife because she's deaf, too, and is easily angered by what she thinks she hears.....

KateRN1 · Jan 23, 2010

If your patient is stable, non compliant, and not teachable then it sounds like you don't have a skill = non-billable to Medicare. These are the kinds of cases that are going to be denied for the agency or requested to have prospective payments returned under the new third-party auditing system.