juliesosarn

hoolahan, it's in the regs. I will try to find it for you. It's not an issue so much for the state surveyors, but it is how Medicare can read the chart if you have to submit it for ADR review. We have never been cited for it because I have never, at any agency, written range visits. I never made a policy allowing it just because it is much harder to track compliance and missing notes, etc. if you don't have specific orders for all the weeks and supplemental orders adjusting those frequencies.

We don't write range visits (1-3, etc.). The regulations say that Medicare and surveyors will interpret the range as an order for the highest number in the range so you will be out of compliance if you only do 2 visits on a week with a 1-3 range. And each agency determines their own week. If your week is Sun-Sat, then an intermittent patient who starts on a Saturday could not possibly get 3 visits in, so why be confusing? It is much easier to track order compliance with specific frequency orders, like 1wk1, 3wk3, 2wk4, 1wk2, for example. The vast majority of our patients get full 60-day frequencies. We can always discharge early or adjust, but it's easier than writing new frequencies in the middle when you run out of orders.

Topaz, I'm sorry that it appears that you have to "write" all your 485s and 487s. Ours are computerized and much easier to do since I would rather type than write. They are similar to what everyone else has said: done at 60 days, state the reason for admission, what services have been provided and what has gone on during the 60 days, as well as a justification for why the patient needs recertification, if he/she does. We also do summaries at 20 days and 40 days, which are directed at the progress toward the goals established in the 485. The 60-day summaries are then easy because we just have to read the 20- and 40-day summaries, then add in whatever happened in the last 20 days.