Shell7280

we are in the same boat basically! i am currently in the process of opening my own home health agency in texas. i got my legal documents through legalzoom.com, i formed an llc. they did all the legal papers, filed for my tax id number, etc. then i hired a home health care consultant to provide me with policies/procedures, job description manuals, application packages, new pt admit packets, every possible piece of paper work. it was the best thing i ever did! they have done everything! they filed my state license app (alot alot alot of paperwork!) :). right now i'm just waiting on the license to arrive so i can go admit my first patients! :). i'm so excited. and any questions that i have about anything, i just email my consultant's team and viola! there is an answer! i have also created many of my own forms/documents, that i'm in the process of copyrighting. michelle

We used to use the 485 only. I'd hate to be redundant and have more than one careplan. :chuckle Besides if you have too much for the small section on the 485...there is the 486 addendum page. :). At one point I designed a care plan but my old employer said it was great but that it is hard to get one approved by state, and it runs too many risks if we utilize our own when they prefer the 485. Who knows what the future holds, thats what keeps home care interesting . Michelle

some programs i've found, but never used...... -- carekeeper - http://www.carekeeper.com -- homeworks - http://www.beyondnow.com -- scanhealth - http://www.homesolutions.net (the one i'll buy when i can afford it !) -- thornberry limited - http://www.thornberryltd.com/productsservices.htm -- visions home healthcare - http://www.accsystec2000.com/accsystec/products.htm i've got no experience with any of these and don't know anyone who does, but what i've found online sounds very interesting. i have lots of ideas for the perfect home care software program, but since i'm no software techie i have no idea how to bring my idea's to frutition. michelle

at the agency i was working at our norm was to code v57.1 (pt) as primary if it was the primary reason we were in the home, not necessarily the only service provided though. then as the first of the secondaries i would put the main dx causing the need for pt. then in the payment codes a and b - put the two main dx causing the need. michelle

top 10 certification deficiencies cited during inspections : by: compliance review services, inc, houston, tx. 1. failure of the agency to ensure care follows a written plan of care established and periodically reviewed by a md, do, or dop. 2. failure of the agency to ensure a clinical record, with pertinent past and current findings, in accordance with accepted professional standards, is maintained for every patient receiving home health services. 3. failure of the agency to ensure a poc developed, in consultation with the agency staff, covers all pertinent diagnoses, including mental status, types of services and equipment required, frequency of visits, prognosis, rehab potential, functional limitations, activities permitted, nutritional requirements, medications and treatments, any safety measures to protect against injury, instructions for timely discharge of referral, and any other appropriate items. 4. (tie) failure of the agency to ensure that drugs and treatments are administered by the agency staff only as ordered by the physician 5. failure of the agency to ensure that agency professional staff promptly alert the physician to any changes that suggest a need to alter the poc. 6. failure of the agency to ensure that the clinical record or minutes of case conferences establish that effective interchange, reporting, and coordination of patient care does occur. 7. failure of the agency to ensure that the comprehensive assessment includes a review of all meds the patient is currently using in order to identify any potential adverse effects or drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. 8. failure of the agency to ensure that a written summary report for each patient is sent to the attending physician at least every 60 days. 9. failure of the agency to ensure that the hha-furnished skilled nursing services, by or under the supervision of a rn, are administered in accordance with the poc. 10. failure of the agency to follow the "condition of participation of medicare". the cms requires agencies to develop, review, and implement a poc for each patient served. these poc's must detail specific treatments and assessments and must be periodically reviewed by the agency to ensure continued appropriateness of the poc. the md must be an integral part of this process, and the agency must accurately record any resulting physician orders. the total plan must be reviewed by the attending physician at least q 60 days, or more frequently, depending on the patient's condition. michelle

i received this list from my consultant and thought it would be useful for others. just remember this was in texas, sooooo. by compliance review services, inc. houston, tx. 1. failure of the agency to ensure client/patient rights are protected under applicable laws. 2. failure of the agency to provide care, including care coordination, assessments, drug/treatment orders, etc., in accordance with a client's care/service plan. 3. failure of the agency to ensure client's resources were not exploited for personal benefit, profit, or gain by agency staff who have an ongoing relationship with the client. 4. failure of the agency to ensure responsible mgmt of agency operations to ensure compliance with policies and procedures and/or applicable state and federal regulations; or failure of administrator or designee to be available during the agency's operating hours; and/or failure of supervising nurse or designee to be available to the agency at all times. 5. failure of the agency to ensure accuracy of billing/insurance claims. 6. failure to adopt/enforce policy to ensure compliance with the occupations code, chapter 102 (concerning the solicitation of patients); or, the agency was operating in violation of chapter 142 of the health and safety code by providing home health and/or personal assistant services, or representing to the public that the person is a provider of home health/ and/or pas for pay without an appropriate license. 7. failure of the agency to maintain current and accurate client records; failure to treat records with confidentiality, and maintain according to professional standards of practice. 8. failure of the agency to ensure a client was not verbally or emotionally harmed (chapter 48 of texas human resources code) by agency staff who have an ongoing relationship with a client. 9. failure of the agency to ensure a client received all goods and services to avoid physical harm, mental anguish, or mental illness. 10. failure of the agency to maintain adequate staff to provide services and/or to supervise the provision of services. hope this is informative. michelle

the texas cms site has a database of all texas home health agencies (very very very long list) with contact info for each. i'm sure each state has this list! and you could contact each home health agency for nurses willing to help with your study. michelle

i like "home care online" website. i also get some "oasis alert" newsletters- about 12 pages each! very informative. they are from national subscription bureau (1-800-874-9180), http://www.eliresearch.com. i get - eli's oasis alert- guide to outcomes, compliance and reimbursement success (email: [email protected] medicare compliance week - news & analysis on fraud & abuse, kickbacks, compliance plans, and enforcement. eli's home care week - news & analysis on reimbursement, finance, law, research, and technology ([email protected]) and they have lots more! they even come pre hole punched to stick in reference binders :) hope this helps! michelle

Hey ! I just wanted to update things! I'm still at my home health care job. I still really enjoy it. And I've been told that I've adapted unbelievably quick to home health care. My capacity is assistant administrator now, instead of merely the office RN. I do all admissions, recertifications, supervisory visits, some prn SNV's, and QA. I am having a problem with getting nurses to understand that things have to be done right, things have to be completely filled out, etc. There are some nurses that I just have no idea where they went to school! They don't even know how to assess their patients. It's very frustrating trying to get nurses twice my age to listen to me, alot of them have serious issues with this. Any advice on staff education would be greatly appreciated! I am presenting an inservice this week (for the 3rd time). Oh and on another, better, note.....I am getting married!!! In October! Michelle

If I wasn't a nurse, I'd be...... A world traveler, and write books about my travels and be the photographer for my books also. .

My position as case manager involves initial evals, recerts, sup visits, prn SN visits occassionally if someone is unable to. I audit charts, contact MD's, and organize aide , provider and nursing service for all the patients. Right now I'm the only one cause it's a new agency and we only have 16 pts. The owner is the administrator and the DON and the privacy officer all at the same time, and much more. She is training me to be the DON when we have enough pts.

Hi! My name is Michelle, and I've been an RN for a year and a half now. I just started working for a home health agency as basically a case manager. Doing admits, recerts, chart audits, etc. I've worked there for two weeks now, and I love it so far. It's pretty good money and it's going to be even better money after 90 days. So I be prepared for newbie questions .

1. RN (ADN) 2. 1 1/2 Years as a nurse. 3. Agency - M/S or Tele 4.$27 - $34/ hr depending on which hospital and which agency I work for that day (work for three different agencies) 5. North East Texas

I am a RN with IBS. I've had it for 10 years now. Don't know if ya have any questions, but will answer any that I can.

I was in an verbally/emotionally/physically abusive relationship for three years. All through nursing school. It was mostly verbally, he'd call me stupid, idiot, his favorite was very demeaning and can't be posted here. He was also 13 years older than me, we started dating when I was 19. So he would yell at me and call me stupid little girl. He was cheating on me all the time, and I'd find little hints and when I'd confront him he'd say I was just being a stupid psycho jealous b****. And when I'd finally get so tired of being called names and getting yelled at and ordered around, I'd tell him I was leaving and I'd try to walk out the door, and thats when the physical stuff started. He'd throw me across the room, pin me on the floor with his knees on my arms till I'd be covered in bruises. ONCE he hit me in the face. He'd sit on me and tell me he was doing it to calm me down, but it really just calmed me down cause I couldn't breath and you can't fight hard when you cant even breath. I remember one incident of a fork flying across a ten foot kitchen and all four prongs stabbing into my leg. My friends and fellow nursing students hated his guts, even though he'd act so sweet around them to me and to them. They could feel his arrogance and his true personality. I started to believe the things he said and thought maybe I did deserve the things I got. I stayed for three years, trying to leave 10 times. He kept promising to marry me and he had bad credit so we bought an engagment ring in my name, which he never payed for. I left two months before graduation, with about 16,000 in his debt that we put in my name, and a broken spirit, and total distrust for men. It's been hard in my new relationship, because of my issues with trust, but I'm lucky to have found someone who loves me and is patient with me.