medicaid visits

caliotter3 · Apr 29, 2015

I stopped doing visits and only do extended care. However, there has never been any difference in how I've done the work or the documentation. If you cover all the bases, then there should be no problem with your reimbursement documentation. My visit employer instructed me to always document some form of teaching along with the other reasons for that particular visit, and I've also received that instruction for documenting extended care. The biggest reason for problems with documentation is not showing teaching, so I've been told many times from many agency supervisors.

PurpleDaisyðŸŒ¸ · Apr 30, 2015

I am being told specifically to chart LESS and NOT to chart teaching (medicaid visits only though, not for medicare visits). That is why I am so confused.

caliotter3 · Apr 30, 2015

I would ask them to give you a specific reason for this. Maybe the rules of the ball game have changed since I did visits. Or, it could just be that these people have their wires crossed. It would not be the first time that I encountered supervisors that provided contradictory instructions to field staff.

Libby1987 · Apr 30, 2015

They're the same but receiving reimbursement is tougher with Medicaid (MediCal here).

With Medicare I feel pretty confident that my OASIS and 485 and visits that follow the care plan/changes in tx for changes in condition will cover reimbursement criteria.

With MediCal I do all of that but make sure medical necessity and skilled service is very clear. It's the same but but I make more of an effort with every supplemental order and visit note.

Where Medicare expects us to provide the care for documented medically necessary care ie LUPA penalties, MediCal seems to want us to continue to prove necessity. Kind of splitting hairs.

KelRN215, BSN, RN · Apr 30, 2015

I am being told specifically to chart LESS and NOT to chart teaching (medicaid visits only though, not for medicare visits). That is why I am so confused.

Why would you not chart teaching on Medicaid patients?

My charting does not change based on the insurer. At all.

softrbreeze · May 1, 2015

Or, it could just be that these people have their wires crossed. It would not be the first time that I encountered supervisors that provided contradictory instructions to field staff.

And HOW!!! lol

Libby1987 · May 1, 2015

Why would you not chart teaching on Medicaid patients?
My charting does not change based on the insurer. At all.

Do you have reimbursement problems with your Medicaid patient population? I think you see pretty sick kids?

We don't have a problem with a clear skill like IV therapy but most of ours are adult chronic illness and we have to pretty much take them as pro bono because the reimbursement has been pretty much nil but we do chart as thoroughly as possible for reimbursement purposes, we don't have to do that with cut and dry Medicare patients.

KelRN215, BSN, RN · May 3, 2015

Do you have reimbursement problems with your Medicaid patient population? I think you see pretty sick kids?
We don't have a problem with a clear skill like IV therapy but most of ours are adult chronic illness and we have to pretty much take them as pro bono because the reimbursement has been pretty much nil but we do chart as thoroughly as possible for reimbursement purposes, we don't have to do that with cut and dry Medicare patients.

Not as far as I've been told. I don't have any Medicare patients right now, one comes up every year or two. Medicaid is the payor for the vast majority of my patients. The patients I see are pretty sick, most are kids with cancer. I chart thoroughly on all patients, regardless of payor, though. In pediatrics you never know when your assessment is going to be the deciding factor in removing a child from her home. That happened with one of my patients last year. Somehow the report I filed with the state was enough and they never asked for my documentation though.

Libby1987 · May 4, 2015

Not as far as I've been told. I don't have any Medicare patients right now, one comes up every year or two. Medicaid is the payor for the vast majority of my patients. The patients I see are pretty sick, most are kids with cancer. I chart thoroughly on all patients, regardless of payor, though. In pediatrics you never know when your assessment is going to be the deciding factor in removing a child from her home. That happened with one of my patients last year. Somehow the report I filed with the state was enough and they never asked for my documentation though.

The Medicare population and documentation requirements for reimbursement are less stringent. What Medicare would consider both a skill and medically necessary is different than MediCal. It would be a cold day before we could just go out on a MediCal patient just for assessment and teaching following an uneventful garden variety hospitalization for CHF, whereas it's expected and routine for Medicare patients. IOW we would have to really justify it with MediCal whereas with Medicare the dx and fraility and/or a new medication alone is enough as long as we document teaching every visit.

PurpleDaisyðŸŒ¸ · May 13, 2015

I have read all your comments, and still trying to wrap my head around this medicaid/medicare difference. Our medicaid patients are chronic and stable. Is that the case for all of you?

@libby1987, it sounds like that is NOT the case for you? I don't believe we see medicaid pts post- hospitalization, ever. I believe they would be switched to medicare if they were no longer chronic/stable.

Libby1987 · May 13, 2015

I have read all your comments, and still trying to wrap my head around this medicaid/medicare difference. Our medicaid patients are chronic and stable. Is that the case for all of you?
@libby1987, it sounds like that is NOT the case for you? I don't believe we see medicaid pts post- hospitalization, ever. I believe they would be switched to medicare if they were no longer chronic/stable.

Why wouldn't you see Medicaid patients following hospital discharge?

Why would your patients be limited to those with chronic problems?

Where is the medical necessity for chronic and stable?

Medicare eligibility isn't based on not being chronic/stable. You're either eligible for Medicare based on set criteria (65, permanent disability, ESRD) or you're not, there is no switching based on chronic illness becoming acute.

To put the differences simply, MediCal (Medicaid in California) doesn't cover a lot of home health services and have denied payment for the same services/same situation that Medicare would have covered. Have you heard of Medicaid denials of other services that Medicare would cover ie tests, supplies and procedures? To get those services covered the documentation has to meet stricter criteria to support medical necessity, layers of supporting documentation. A Medicare patient is hospitalized with CHF and is homebound, besides the MD order and a POC, a simple statement of SN for skilled observation of s/s CHF, response to new med and patient teaching, and you're done. With MediCal, there better be a strong explanation why patient can't just be followed as an out patient, you have to practically build a case.

We don't *have* to document differently but it's known that it helps to make sure you've included everything relevant to need, every note. Or you have a very strong tangible skill ie complex wound care versus patient teaching.

Does that make sense?

With sick kids it may not be as tough, with adult chronic illness it is.