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carwin's Latest Activity

  1. carwin

    Christmas Eve in Home Care

    Great job and Merry Christmas to both of you. If not done already, get an order for a protein level.
  2. carwin

    Face-to-Face Rule

    yay! we have more do and track and write policies for!!!!!!!!!! we are planning to ask at receipt of referral and having the opening clinician ask when the md was last seen or when is the next appointment. we will have the intake person make a follow-up phone call to make sure the encounter was made. i'm sure we will tweak this many times before we are pleased. we are sending out faxes/mailings to all of our doctors with the info below about the face-to-face (ftf) from [color=#0e774a]cahabagba.com the final rule amended the code of federal regulations, 42cfr part 424.22 as follows: the physician responsible for performing the start of care home health certification must document that a face-to-face (ftf) encounter was performed within 90 days prior to the start of care (soc) or 30 days after the soc. the encounter must be related to the primary reason for admission to homecare. if the ftf encounter occurred within 90 days of the soc but is not related to the primary reason for home health, the npp or certifying physician must have a ftf encounter within 30 days after the soc. * the ftf encounter may be performed by either the certifying physician or a qualified non-physician practitioner (npp). an npp is defined as a nurse practitioner, clinical nurse specialist as defined in the social security act section 1861(aa)(5) who is working in collaboration with the physician as defined by state law, a certified nurse midwife as defined in section 1861(gg) of the act, or a physician assistant (as defined in the social security act section 1861(aa)(5)) under the supervision of a physician. * the ftf encounter may not be performed by either a physician or an npp whom is employed by or has a financial relationship with the home health agency as defined in section 411.354. additional information regarding this topic is also accessible in section 424.24. * the npp performing the ftf encounter must document the clinical findings of the ftf encounter and communicate those findings to the certifying physician. the certifying physician is responsible for documenting the ftf encounter took place. * the ftf encounter may be performed through telehealth. this must be performed via medicare eligible telehealth services. for information on what constitutes medicare eligible telehealth services, see overview telehealth * documentation of the ftf encounter must be a separate and distinct section of, or an addendum to, the certification and must be clearly titled, dated, and signed by the certifying physician. the documentation must include the date of the encounter, that the condition for which the patient was being treated in the encounter is related to the primary reason the patient requires home care services, and why the clinical findings of the encounter support that the patient is homebound and in need of medicare covered home health services. the home health agency may not formulate standard language on the certification forms related to the encounter. these regulations take effect for home health start of care certifications occurring on or after january 1, 2011. as a reminder, all certification documentation, including the ftf encounter documentation, must be signed and dated by the physician before the claim is submitted to medicare.
  3. carwin

    Horizon Homecare MobileCare-GPS TRACKING

    Although a new software system or a form may be put in place in our respective agencies, they are only tools. Tracking software could prove to an FBI agent that you did make a visit and the fraud in the agency lies with the sweet little biller in the finance office. That's where we are in home health these days because of fraud. I'm in a high-fraud area and many of my posts run along that vein. After reading many entries in this forum, I've wondered (I hope erroneously) if my fellow nurses know what's happening in our industry and how we are impacted. Depending on the management team to inform staff might be laughable in some cases. Medicare fraud is big, RACS and P4P are here and AS MANAGERS WE NEED TO INFORM STAFF of their roles in all of this. Too often people are told what to do without a reason why. Grown people want to know why. The office QA person should be there for you and I'm sorry not an LPN. QA needs to be all over these sites so they can interpret to staff what is needed. To expand your knowledge on what YOU NEED to know, Google some of the following terms: home health compare, home health fraud, pay for performance in home health care, etc. Pay for performance (P4P) is why you need to complete the OASIS to best of your ability. So yes, we all need to do it better. The link below explains in a nutshell home health agencies being paid incentives for good outcomes. The Home Health Compare compares SOC OASIS to D/C OASIS. The public is advised to look at this site to see how well an agency provides care for its patients. Are you willing to do it better so your agency is chosen over another? Centers for Medicare Medicaid Services then search home health-all you ever need to know is here Medicares Home Health Pay for Performance Demonstration Year 1 Incentive Payments Issued Medicare.gov â€" the Official U.S. Government Site for Medicare OASIS Answers, Inc. The fraud in home care is ridiculous. Seven cities are being targeted by the feds. There are things some of you may be doing and not realize it's fraudulent. Are you making corrections the right way or should you touch that documentation at all?!?!? Your management team may not know either. Public service announcements are running on TV and radio stations to inform the public to say no to people offering gift cards, house cleaning, etc. Stop Medicare Fraud Recovery Audit Contractors (RACS) These guys have mining software (tracking the agency) that arbitrarily pulls records for review is you bill m-caid or m-care. These guys are to identify and recover overpayments made by Medicare Advantage plans, Part D and Medicaid. Agencies must self-report and return the overpayment in 60 days. Now if there is charting that does not support the plan of care, they will say you didn't do what you were paid to do. US gov takes the money back. Of course the RACs get a percentage of what they recover so you know how fine-toothed their combs are. What if they want money back on 20 cases? That amount could equate to hundreds of thousands of dollars and close an agency immediately. Private insurance companies have always done this. Overview Recovery Audit Contractor Take care of yourself by informing yourself. Ruby and Dijmart tracking sucks but never do you want an unscrupulous manager blaming you for visits not made to cover themselves for what they aren't doing. I've seen it happen. When I've talked to nurses and other clinicians who have sat with FBI agents, they were happy to have proof they were in the home.
  4. carwin

    Help! homehealth agency in Atlanta,GA?

    If you don't know anything about home health, stick with a hospital-based agency or a large agency that can put time into a well-organized orientation for you.
  5. carwin

    Horizon Homecare MobileCare-GPS TRACKING

    Honestly guys there is no time in the office to sit and track nurses all day long. Agency owners who hate to pay up may have time to watch the tracking screen all day. There's not enough time to do what's needed!! If you are hired full time, that is how an agency could verify that you are putting in your time. If you are contingent, why do you need to be tracked? As a manager myself who was once in the field, I would only use tracking (if we had it) to help explain why things aren't going the usual path or patterns of consistently late paperwork or patients always calling looking for the nurse. Spouses ALWAYS call the office! I've told some nurses, I think your hubby is checking up on you. The funny thing is that I eventually found those same things out anyway without those devices. It might take longer but you find out. There are people who just don't like being "watched" so they should move on. I would have loved to have been tracked when I was in the field. I would always think if I ran into a deep ditch who would find me.
  6. carwin

    Hand washing question

    Think about, if we as nurses have not heard about many of these tips, then what about the general public that doesn't have nearly the knowledge of infection as we shouild have? People use the bathroom and if they choose to wash their hands, they turn on the faucet with bare hands. Not everyone has a whole cushion of Charmin in hand as they wipe. I don't want to touch touch my own waste, much less anyone else's.
  7. carwin

    Hand washing question

    No this is not a universal policY but something an infection control nurse told me when I first started nursing m it makes good sense to me.
  8. carwin

    Home Care Fraud - How to escape.

    Yes, currently in an electronic environment and love it. QA can read the notes!!
  9. carwin

    Hand washing question

    My nursing friends, we should also wash our hands BEFORE using the bathroom.
  10. carwin

    Give prn meds because Mom said to give it?

    Tell Mom that she is able to use her discretion, but you are bound by law to follow the med sheet as ordered. You can appease Mom and call the PCP for and order change.
  11. carwin

    Hand washing question

    People wipe themselves, then turn on the faucet! That vision is explanation enough.
  12. Tell the supervisor that the doctor is involved and you are waiting to see what's next. They may not return your call for an elevated BP reading but they are usually good with abuse/neglect situations. If your patient had a vs outside of parameters or was experiencing a side effect of a drug you would have called the doctor first. Next time, and there will be something like patient being physically abused by a cg or financially abused call the doctor and get the MSW ordered if it's safe to go back to the home. Then, tell the agency. The agency has to go with the flow at that point. MSWs are really good with what they do. Let your team member on the field! Now sometimes if it is a physically abusive situation, I've been calm. Told the family member that the BP is high enough to call EMS. If I can't tell the dispatcher the reason I'm really calling, I have it written on the sheet where I've been recording the "elevated" BP readings. When they arrIve, show them the BPs you've taken and point out your note re: abuse. Just do something! Don't ignore. Remember, that could be you in a few years.
  13. carwin

    New grad, new to home health - overwelmed

    I agree with Kate. Home health is not another floor in the hospital. Home health, the business, is run quite differently than a hospital. Ask the hospitals that sold their home care agencies. As a new grad you need to first learn how to nurse confidently. Remember you don't have colleague nearby to listen to lung sounds for you. The LPNs, should not be rude but they have to work under your leadership. It is frustrating when the leader frequently cannot roll out the answer. You have a lot of patients that I hope are not being mismanaged. Best wishes to you and to your patients.
  14. To MindyTX, great policy. I can't believe the stuff I read in these posts. I get sick to the stomach.
  15. carwin

    Home Care Fraud - How to escape.

    You must report or may be considered a part of the crime.
  16. APS will contact the cops. I would only contact the cops if you really know something for sure or if something happened to you. APS will handle it from there.