Need HH advice..

[JennyHHRN]

Hi, I stumbled upon this website and now I'm addicted! I've learned more info r/t Home Health here than I did in orientation!

Okay, I need some advice. I recently took a position as a HH supervisor. Our prior sups are going through a messy trial over medicaid/medicare violation of homebound status. I feel these nurses are innocent and their lives have now been destroyed by what started out as a witchhunt by some disgruntled employees.

So after holding the positions open as long as possible our hospital had to post their positions. I didn't want to seem disloyal by placing a bid but didn't want to take a chance that someone from outside our dept get the job and make our lives miserable. So here I am, one of the new supervisors.

I would love any advice any of you have to share. We are a great team in the small hh dept I work in and I hope I will always keep in mind that being out on the road is no simple task. It's hard to stay positive when so many tell me I'm crazy, why take on more stress, and often feel as though I just sold my soul to the devil. (now that's a bit dramatic) I would especially appreciate any info on regulations, standards, etc to keep me out of the same legal trouble my collegues are in. Thanks!!!!

[Mijourney]

Congratulations Jenny for taking on this risk. Hopefully, it will help add to your growth in your nursing career. I don't have any in depth advice except to suggest that you review your state nurse practice act if you haven't done so and consider joining a reputable home health organization. It is a plus if the organization you choose has a local chapter. Most states have some sort of state oriented home health association that you can network and get information from. Best wishes.

[NRSKarenRN, BSN, RN]

biggest thing for you is to encourage staff to go forward. insist on clinical documentation to reflect homebound status be clearly documented monthly in notes and with 60day summary. we include a checklist statement combined with clinical assessment in oasis recert package. minimum of weekly wound assessment using flow sheet. if no change/improvement in 3 weeks of treatments, consult to pcp/cetn re trying other treatment. daily wound care greater than 6 months, cut back to every other day to prove worsening status of wound without daily visits (1 week trial). daily wound care greater than 3 weeks must have end date statement from doctor or medicare won't pay. lab work on file prior to start of care + periodically (min q 3 months) for all clients getting b12, epogen, neupogen etc and documentation of why patient unable to self-inject initial note and q 60 day summary etc. for home alone patients over age 65 without caregiver, msw eval first admit to determine long term care needs. if followed, these documentation tips should keep you out of most trouble.

read and know rules: rev 8/23/14

CMS Medicare Benefit Policy Manual

Chapter 7 home health services

all medicare and medicaid rules + regs here. updates sent as transmittal memo's.

check out what medicare considers fraud and abuse:

http://www.medicare.gov/forms-help-and-resources/report-fraud-and-abuse/fraud-and-abuse.html

see if agency gets home health line (hhl) or eli's report, two weekly professional home healthcare publications providing home health news, legislation, and regulatory changes

reference site:

pam pohly's net guide: toolbox for health managers & administrators

this toolbox for health administrators provides 13 pages which contain articles, information and links to other websites pertinent to managers and administrators working in healthcare. you can find information about health economics, medical and insurance legislation, industry news, legal issues, regulatory, compliance, policy, business planning resources, human resources, careers, terminology and more.

http://www.pohly.com/admin.shtml

good luck! come back to vent anytime.

[hoolahan, ASN, RN]

Can't give any better advice than Karen. I can only add re documenting HH status, I start off each note with a "snapshot" of what makes the client homebound...

"Ct in hospital bed, responds to tactile stimuli.."

"Ct ambulates with walker, but requires human supervision provided by paid live-in CG"

"Ct ambulates with cane, has great difficulty with position changes sitstand."

I am curious to hear more about the charges brought, if you don't want to post it here, would you pm me? Of course I don't want to hear names, name of agency etc. All I can say is this, keep your eyes open. I just had a horrible experience with Medicaid fraud where I used to work, and all is not always what it seems. I am saying this b/c you said "some disgruntled employees", and it worries me that you think some people may have reported people to Medicare as a spiteful move. ??? Maybe I am misunderstanding. In my personl experience, in these kinds of situations, guilty parties will tell all kinds of lies, falsify documents, etc to cover their buts, so if someone has made a charge, I would tend to think there is something to it. What I do find unusual is that the sup's were involved? I would think the CM and nurses directly involved would have been cited. In my agency it is the admission nurse who decided if a client meets homebound criteria, and the nurses who visit regularly who determines the ongoing homebound status. Our supervisors virtually have no idea other than what we write, as to the homebound-ness of a person. That is why I am curious. If possible, it would be nice if you could give us some info so we can be sure we never get into that bind as well. There seems to be much more to this story.

Just curious, and esp cautious after my last experience.