Missed certification visits.

AnnemRN · Dec 24, 2006

No, I believe you will have to discharge then readmit the patient if you miss recertifying the patient in the last 5 days before the plan of care ends. I know it's a headache but, notifying the doctor will not cover you.

Wgbem · Dec 24, 2006

Yes, you will have to discharge and readmit the patient. The paper work is more for the insurance or legal aspect of homecare. It is not for the benefit of the doctor. It is a pain but it does have to be done.

DutchgirlRN, ASN, RN · Dec 24, 2006

My question would be why are the recert visits being missed? Is the patient not homebound? Not compliant? If this is the case they should be discharged and not readmitted.

Wgbem · Dec 24, 2006

I know that visits have been missed in our agency because there are only 1-2 full time nurses at any time and the rest are per diem. Sometimes they may be giving that patient over to the per diem nurse and they lose track. You as the full time nurse have such a large patient load that you lose track. I have seen many full time nurses quit because of being overwhelmed. It is not the best situation but it does happen. The patient can be homebound but it is the office, not the patient that misses the recert.

AnnemRN · Dec 24, 2006

I understand what you're saying, in the agencies I have worked for the schedulers and supervisors try to keep on top of the recert visits so that doesn't happen.

I think they've learned over the years how much time and effort it costs by not helping the nursing staff be compliant with important dates in the plan of care.

DutchgirlRN, ASN, RN · Dec 25, 2006

Ditto. We are assigned recerts. Full-time, Part-time or Per-Diem, they know who is working the next day and assignments are made out for the following day. The recerts must be done unless the patient has a legitimate reason for not being available in which case the recert is rescheduled for the following day. They are really good about staying on top of what's due when. The clerical staff keeps us in line. God Bless Em!

Jo Dirt · Dec 25, 2006

We have two full-time RNs (well, the other one just quit...this is the third one we have gone through since I started with the agency in April of '06, I'm the only one who has hung around this long). Each RN is expected to cover 4-5 counties. So, yes, we get a bit overwhelmed and burned out putting 1,000-1,500+ miles on our vehicles every 10 days. And missed visits do happen, and for a variety of reasons.

The HH agency in the county where I live is VERY choosy about the patients they will accept and what nailed me to the wall is that they employ FIVE RNs and they only cover this county and perhaps a little way into a couple of the outlying counties. And since these five RNs have been with the company since it started 10 yrs. ago there won't be any positions open anytime soon. So, if you work for an agency like this, I can see why you would say there is no excuse to miss a visit.

But for the rest of us, yes, we have to discharge and readmit. This is incredibly annoying. They want people to use their time effeciently but then bog you down with 12 more pages worth of crap to fill out. It never ends.

Seems like there would be a simple form.

I hope I can get out of this nursing business soon.

homehealth43130 · Dec 25, 2006

CMS has answered this question (OASIS Q&A page)- you are to continue seeing the patient under the new plan and do the recert as soon as it is discovered that it was missed documenting the reason for the missed recertificaiton. You will also get an error message when you submit the OASIS. The only reason you need to discharge and readmit is if there was an intervening admission to an inpatient facility and there were no qualifying visits in the new certification period.

caliotter3 · Jan 4, 2007

At my hh agency I would see the supp order where the DOCS would be informing the MD that the recert visit was not made and asking for MD to recert. Everything went on as usual. There was no discharge/readmit. The way they were handling administrative work at that time, heaven forbid! And this was every pt I went to, I was wondering why the recert/supvr visits were routinely being missed. They had an employee who was supposed to be doing this function. (I think she was leaving the office on a daily basis with a caseload of visits, but not necessarily "visiting", as I got a call from her one day and by the background noise it seemed like she was out gallavanting around somewhere!)