Need info on missed visits please

[masen]

WE have been goign back and forth with this one. We are a JCAHO Accred. Home care agency, and my question is when we do a plan af care and send the 485 to the physician for an RN to do a 2 visits for 9 weeks and than the nurse happens to go only once one the 3rd week cuz patient did not want to be seen. We do a missed visit log and thats it, but i have been hearing that everytime u miss a visit a cant make it up in that week you need to send an intrim order to the physician for signature is this true or what is the truth?

[renerian, BSN, RN]

Here is my take. The doc does need to be notified of the missed visit but they do not have to sign it. The form has to say the date of the missed visit and the doc notification. I am not sure if you mean you cannot make up the visit in the same week or a different week. You can make it up in the same week. If the client has a Dr. visit then I usually change the day anyway. The state will look for Dr. notification. Now this is in Ohio. Do your state regs say you need to send an order or is the missed visit note with doc notification okay? That is the most key question to ask as it varies most likely from state to state.

Does that help?

renerian

[wenron]

We use an interim note that reads "pt refused visit today due to....SN frequency not met for wk.... We don't have to right an order for this, but they fax this to MD.

[dragonfly954]

i am new to HH Medicare visits by a couple of weeks.I've heard everyone talk about missed visits.We have a form for this,yet i have not had a missed visit yet.My question is does your agancy factor in missed visits into the total # visits?Scenario from last week:Have a stable GI bleed to be seen.Agency says medicare doesn't like to see just 5 visits from SN.It looks like you are just doing the minimum visits to get paid for the entire episode,so they like 8 as an average.So they did 2 week 1,3 week 2 to make 8,stressing that 2 missed visits would be ok due to the holidays.Is this normal.You answered the question of md order needed for missed visit.

[Nurse Soc Mom]

Our agency always has us do an interim order to the MD re: the missed visit and rationale as to why. Makes sense to me to keep the MD up to date.

[KLQ727]

Our agency is JCAHO also, but it wasn't JCAHO who required the order for the missed visits. It was a Medicare Survey that dinged us for not having MD orders for missed visits.

Documentation in the chart was needed to explain why the visit was missed, but needed the MD order to show that he/she was informed of, and approved a change in the plan of care.

Their reasoning was that ANY change in the plan of care has to be ordered by the MD. Just the same as any treatment does. Makes sense... that's the rule, but we all get used to actually doing just a phone call or log, etc.

Had we originally written on the 485, for example, 2w4 except for weeks when seen by MD (may make 1 visit only) then we only needed to make a note in the chart. However, if the reason for the missed visit was not for an MD visit, we still needed an order.