PLEASE - need Home Care Flow Sheet samples

[CharlaRN]

To make a long story short - a 3rd party is calling 1-2 page Home Nursing flow sheets "fraudulent" as they do not show enough documentation to pay for an 8-12 hour shift worker. Stating that "the care documented could have been done in 3 hours rather than the 12 hours billed", the 3rd party is planning to demand repayment of wages.

The patient gets 12 hours of nursing a day through Medi-Cal. The 3rd party issues the checks, and has skipped over Medi-Cal's documentation requirements (which are followed) and is looking at the documentation as being the problem in billable hours. Every Home Care Flow Sheet I've ever seen is basically the same... checks, notations and 1-2 pages long. So, EVERY Home Care nurse faces an uncertain future of being accused of "fraud" by documenting care this way if this is not nipped in the bud. (this is a 12 hour shift worker caring for a Medically Fragile child on TPN with GT feeds and organ failure)

Nurses - you know how we see the smoke before the fire.......it is SMOKIN' HOT right now. Please, I need sample forms from any Home Health nurses to show that nursing documentation in the home UNIVERSALLY is done with a check and narration system utilizing one-two pages - it's NOT required for the Home SHIFT nurses to completely rewrite a Nursing Care Plan everytime they do shift work in the home! This is NOT a "visiting nurse", it is a 12 hour shift RN being told this form of documentation is not enough to "prove" 12 hours of care was done!

Thank you!

attachments can be sent to Chars Funny Farm @aol.com (no spaces)

my fax is 1-314-689-8160

[caliotter3]

Simple, put the start of the shift, the end of the shift, and other pertinent times in the shift report, usually in the narrative. I also used to put times at the check-off points. For example: if I started a tube feed at 1400 and it went until 1445, I would write "1400-1445" next to tube feed with rest of notation, such as kind of formula. If I gave a back rub at 1700, "1700" next to the notation for back rub. In the narrative, "1100- Assumed care. Vital signs taken: blah, blah.....Assessment done per flow sheet, noting ..blah, blah. 1400-Enteral feeding blah, blah. 1450-Called Dr. Smith, notified blah, blah. 1800-Blah, blah 0330-Relinquished care to Suzy Q, RN. Departed home. All one has to do is to put times all over the nurses note, paying strict attention to start and finish times for the shift. Don't have specific examples to send, but I think this isn't difficult to deal with. Don't know what their problem is, unless the notes don't show times at all.

[CharlaRN]

Thanks, Caliotter,

This is an audit (like the IRS picking a random nurse to audit). They have an independent nurse consultant who has decided the documentation does not show that the nurse - who billed for the 12 hour shift - showed enough documentation to have them PAY for the 12 hour shift that Medi-Cal has given the child. The auditors are skipping right over Medi-Cal, and going after the nurse based on "not enough documentation" to support her being there for a 12 hour shift. Any Home Care nurse, especially those on night shift, know that there is down time when the patient doesn't require hands-on care - yet, requires the safety of an RN to monitor their status. The paperwork was filled out thoroughly, and done according to Medi-Cal guidelines (which have been fine for 4 years of billing Medi-Cal). Now, the independent audit is looking for "fraud" based on THEIR position that it is not enough documentation to support paying for a 12 hour shift! (Medi-Cal assigned the hours!)

Very frustrating - and, a reason I need to gather as many samples of Home Health - even Med Surg - flow sheets to show that there was, indeed, "enough charting" per other Hospital and Home Agency standards.

[caliotter3]

Ninety per cent of my shift time on night shift medi-Cal cases has consisted of sitting in a chair (preferably a rocking chair!), watching my patient's breathing patterns as they sleep. I still have to be there to monitor them, whether there are alarms set up or not. I can see where there would not be enough charting for many (most) of my contemporaries. I can visualize the charting of one nurse at a former agency that would fit your bill to a T. She would go up into the check-off portion and go to town. She put in times of diaper changes. Each time she changed position of the patient she showed it, 0200-L side, 0400-R side . She put stuff up there that I hadn't even thought of and I learned from her charting. Too bad I don't have a copy of one of her nursing notes to send you. If all your nurses charted like this individual, you wouldn't have anything to worry about. I agree that this auditor is going overboard. I think they just want to cut the hours anyway. We used to get hours cut all the time, but I was told that it was because the agency didn't provide nurses for the hours authorized. Not used, not needed, hours therefor cut.