dgd123

What is everyone's favorite software. I have worked with Delta and with PtCt/Maestro. I hear McKesson is good? Our agency is getting ready to switch software and just curious. Will need it both for clinical and admin/billing.

Mileage reimbursement can differ greatly by agency. The IRS sets the rate (currently 48.5 cents/mile) and an agency may choose to set their rate at this (ours does) or may pay lower. As far as when to start your mileage, our agency starts it at first patient's home or the office, whichever is first. This is also when our time on the clock starts. Now, just because it says office, does not mean you actually have to go to the office. Agencies get this verbage from the IRS guidelines on travel which say that your non paid "commuting miles" are those from your home to your primary office. For instance, I live 30 miles from the office so daily I would "lose" 60 miles because these are my commuting miles. Does anyone know why an agency can start paying mileage at 10 miles? I thought this was against IRS regulations. If not, I would sure like something in writing about this because I think this is a fair way given that agencies need to hire people in the outlying areas to cover the patients who live in these areas. More food for thought---More and more agencies are on laptops now and the nurse starts and ends the day from home. I get up and import my charts, call my voice mail, my patients and head out the door. We even store all of our supplies in our personal vehicles. Most agencies encourage us to work from home, especially since there isn't enough room and we don't have desks or computer hookups available for everyone in the office. In light of this, I would like to know if anyone knows if IRS would consider our home our office, at least for mileage purposes. Of course, we get paid for this time but we have to clock out when we head out the door and then clock back in when we reach our first patient's home. It is definitely a dissatisfier with staff who live far from the agency "office". Please let me know if anyone has written material to help us on this.

At our agency the person who codes is also the one who takes in the majority of our new referrals (we usually have about 120 patients on census) AND reviews all Oasis/admission charting. We have an RN in this position. Is yours an RN? I can't imagine why it would take so long unless he has other duties.

That agency is committing Medicare fraud and hurting the other agencies in the area and setting them up for failure. Sure, they are appeasing the patient and their family but it is wrong. Remember also that a patient can not "agree to be homebound" either. Homebound is functional and you either are functionally homebound or not. There are a couple of exceptions to this such as when patients are a threat to themselves and must go with their caregiver for their safety-Alzheimer's, some psych Dx, etc. Also remember homebound does not mean a person can not leave their home. A person is homebound if they only leave their home "infrequently, of short duration and it is a considerable and taxing effort". Don't you love how vague this is. I still hear nurses telling patients they can only go to church or the barber shop and this is really not the case. Church and barber were examples given in the Medicare regs so many people fixated on this. In fact, you would not be considered homebound if you were able to go to church daily for hours. Was that agency you worked for a for profit agency??

I currently work Monday through Friday and do triage call for 7 days (broken up)every 8 weeks. This is the best I have had it in home health. When I first started at this agency, we had to also do a Saturday and Sunday every month seeing regulary scheduled visits (8A-5P) and when we did this we were off the Thursday before the Saturday work day and the Tuesday after the Sunday work day. Some people liked having the day off and others would have preferred the overtime-can't please everyone. We got so busy and burnt out and spoke up and they hired a weekend RN initially then added a weekend LPN. I am very lucky that I have a progressive, open-minded management team. I have been on both sides-management and staff and have left 2 other agencies due to poor management at one and ethical issues at another. I have done home care for 12 years and love it compared to hospital nursing. Top 3 satisfiers for home health: autonomy one-on-one patient care flexibility -- when my son was younger I could make my schedule revolve around activities at school, can do paperwork and phone calls at home, can run errands, etc. Keep in mind you need to subtract the time you are not working (unless on a break) and this may mean that if you took off 1 hour during the day, you will find yourself making up the time at night. Hope this helps.

It is good but the current allowable reimbursement by the IRS is 48.5 cents per mile which is what 2 of the 3 major agencies in our rural area are paying.

Depends on the number of referrals/number of RN's working. There are some weeks where we get one every day (sometimes even 2) and it is very stressful. Our productivity standard is 5 visits per day for RN's and 6 per day for LPN's and mileage is about 80 miles per day. We use a point system for productivity where you are supposed to do 5 points daily. An admit is 3 points and regular visit is 1 point, so a full 8 hour day would be 1 admit and 2 regular visits. This supposedly gives time for case management, however, they do not count meeting time or time for chart audits in the productivity so it is not an effective or equitable tool. Some of us are on numerous committees and attend all meetings, where others do not. Another problem is usually we wind up having 6 points per day and everyone knows how it is when you get behind 1 or 2 days... it seems like the paperwork will never end-an we are on laptops! Overall, it is the best job in nursing for me-I have been doing home health nursing for 12 years.

I am interested in knowing how much the person is paid that your company hired during the week and what her duties are, if any, other than on call. I have worked in home care for many years and have had informal discussions on hiring an on call nurse for Monday through Friday but would like more detail to do a detailed proposal. Thanks.

My hospital does not offer a pension but we have a 401K in which if the employee invests at least 1% of salary, the company invests 6% of our annual salary. It is a good plan. I did work for another hospital for 8 years which had a pension plan and I will get about $300 per month at retirement from them. I wish we could have a system like teachers where all our years of service count so we could retire after 30 years with about 80% of our pay AND health insurance. Still dreaming.