carwin

Report it. These actions are the source of billions of dollars in medicare and mdicaid fraud. That nurse is not providing care and is stealing.

Yes have the lab fax to the doctor but you still call to make sure they receive the results and get your orders. if you draw a lab, you are responsible for obtaining and reporting the results to the ordering clinician. Then, CHART it. I always say call the lab yourself because labs drop specimens, they don't pick up specimens and you won't know until you call them. I will leave that nation-wide lab un-named.

RN 1263,well aware of the subject, just sharing a little extra knowledge picked up from CMS surveyors. Whatever is done on ANY computer can be tracked by the IT person and your software vendor. Some software vendors term is a work log which shows who did what on any chart. No one can say they did or didn't. Do something. We have clinicians sign forms at hire giving permission for correcting the OASIS after a phone call (paper or point of care). The corrections are made after a phone call to the clinician. We complete a correction form and place a copy in the clinicians mailbox and personnel file. RN 1263, reviewing those forms allows me to see which questions are a problem (widespread or individual)and I can address that in a staff mtg or 1:1.

I code and I lock the OaSIS. That's a little paranoid. Home care is trust all the way around. Office staff have to trust that visits are really being made on the dates that are stated and that what is being written was actually done. Clinicians have to trust that their work is not being changed. Quite frankly, if I could change anything, it would be the revisit notes. Many people have a difficult time completing those to reflect that skilled care has be delivered. What makes you think your company is doing that and if they are, why not report them, why do you remain? Continuous locking and unlocking can trigger an audit. It's called teamwork. You are throwing the one having to lock and unlock your OASIS under the proverbial bus. I don't change anything because I've not seen the patient. I don't know your situation or your skill level in completing the OASIS but many agencies have not oriented as well as they should as well as having occasional reviews. I have my nurses select their answers by starting with the last answer and working backward. Remember you are selecting the answer by what YOU OBSERVE the patient doing SAFELY!!!!!! Did you see them put on pants, pullover a shirt, can they read and comprehend?! Always let us know about poor vision, HOH, dribbling is INCONTINENCE!!! Some people are incontinent because they can't get out of the chair and walk to the bathroom quickly enough. Writing from phone right now but I will post the link from CMS for the chapter that tells how to answer the OASIS. It also states the intent of each questions. We all need to frequently review this info. I've been in the field and I understand. Home care is a team effort. I first preserve my license and that of my clinicians. I hope things are better than you think they are!

The accrediting bodies charge for their services. Why would they come out and risk not getting paid? Many people do not know that the agencies pay for those surveys. Those surveys are a few thousand dollars even if the census is around 15 patients. Notify your state home health hotline. If you have to report them. It's no crime in being broke. My most timely pay including direct deposit was from an agency that I found was making up visits. I quit. You see the obvious. Why not just stop accepting patients from them? At some point, they won't be able make your check good. I don't know what you keep up with outside of seeing patients as far as the home health industry goes but this industry is undergoing big changes. Many of these changes are some that will close the smaller agencies. The recovery audit contractors' audits can take money back if the documentation from field staff does not follow the care plan. Agencies have shutdown real fast due to those audits. I hope there are other options. By the time payroll is affected, things are bad. That means that there is no line of credit securing the agency. An owner knows people won't work if they aren't paid. Good luck to you. I hope there are several options for you.

I welcome you to the profession. So sorry this happened to you as a new nurse. This is why I like to see new nurses in facilities first before striking out in home health or private duty. I feel you need to be mentored by the nurses you interact with daily. Then in a situation such as this, you know your skills aren't a question. Especially because you're new to nursing, I think your supervisor or DON should give you the reason why this happened. As many have stated, it may be no big deal. I wish you well. Please try to find opportunities to be mentored so that you increase your skill level.

I knew just knew you were in fla or southeastern michigan. These are two areas that are overrun with home health agencies. Cash flow can be a little goofy at times in home care. I've been at well established agencies and had that happen but they been able to move money around to meet payroll or cover you the same day. You really should look for another place because of 1, you are in fla and 2. If they can't get money in a day or so, it's only going to get worse. The economy is bad , lines of credit are hard to come by and these younger agencies are often started by engineers who started the company with their Ford or GM buyout money. Good luck to you

Try calling a family member

Completely agree with txredheadnurse. While many of these workers are not trained along with having limited education, many have some of the biggest hearts. I worked for a home health agency where the owner had 5 group homes. The workers often called needing toilet paper, cleaning supplies and yes food! These workers have pooled money to buy food, deodorant for clients while the owners get GOOD money to care for these residents. THe group home owners skimp on getting qualified help and/or fail to train good-hearted staff. Many wat to know more and the owners won't put out money to orient. As with any job you have some who do the best they know how and want to do better and those who know what to do and are too lazy. The oversight of the homes is sad.

Sooooo true Nurse156. My concern is that you are not separating your work and personal times. Nursing is very demanding physically and emotionally. Work on building a strong, positive personal life so that you won't need to rely on your professional life to fill that need for you. If you lost your job, then what would be your support system? Take care of yourself.

Keep your relationship with your patients professional. Ditto ArwenEvenstar. I heard of a case where nurse is taking care of Grandma. Nurse and Grandson start to date...then comes an ugly breakup! Grandson calls the state board of nursing and tells how Nurse would give GM ibuprofen or an enema, etc. Nurse went through the blues with that. Never confuse the relationship! And I don't friend co-workers. My FB is family and very close friends. Co-worker don't need to know all of you comings and goings.

The legal mess would be creating a visit note or OASIS when no visit was made.

Give it a try. This is a large company that should have an organized orientation process. Contrary to popular belief, home health nursing is not the "easy job" or "in and out". Just because you're sitting in the family room seeing the patient, your professionalism must remain intact. Anything you report to the RN or MD in acute care, you do in homecare. Documentation is everything. You will be teaching meds, disease process, etc. Doc what you taught and patient's response. You will marvel at the impact you'll have on teaching patients and or their families. You must be organized and approach it very business-like as far as setting up visits so you're not wasting time and gas. Call patients the night before and verify the next day. See those patients first thing, and complete that paperwork daily!!! Best of luck!

The "need a paycheck" mind set is one of many reasons we're not a profession. Bottom line, a new nurse requires learning experiences that are interactive and varied before taking on the very independent role as a home health nurse. When you sign up, you're saying "I can handle this". In home care, you ARE the backup. That's why the patient is at home because a competent, confident, professional nurse has been provided. The only back up you need is 911. The doctor's expectation is that you would have assessed a situation and handled it. The doctor expects you to call to say this is what I assessed and this is what I did or planning to do! You are the eyes and ears out there! Please respect your hard-earned licensed. Don't offer it up so easily! And don't get me started on the fraud side of HH that greedy agency owner can pull on the newbies! Home health agency owners love you guys.

It takes about 18-36 months to get a medicare number. You will be paying out of pocket to see patients until you can bill m-care. There are way too many changes that are decreasing payments. Until we see how all these changes come to pass, I would not even think about it. Docs are more apprehensive about referring patients because they don't know if an agency is playing right or not. The bad guys have made it hard for the ones who want to run an agency right. Good luck to you.

Nancy, They are running a game on you. You are only the name on the org chart. I wonder how many of those visits are actually made. The bosses are not clinicians are they? The bosses are nice because they don't want you to figure out the game. That is not going to change. Start looking.

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

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.

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.

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.

EE you and fellow clinicians need to get together in a professional way so that you come across business-like and not as whiners. See if clinicians are spread out geographically smart. Are there 2 people working over each other? See were clinicians live and let them establish that area as their area. If two live in the same area, whomever was there there first gets the area. As more clinicians come on board, they can start helping out in an area thereby dividing the work in half. If you are charting point-of-care great! If you're on paper, mail in paperwork 2x per week. Make sure you call in your starts, ROCs, recerts and D/C to the off as soon as the visit is finished. For supplies suggest the agency use a company that will drop-ship supplies to patient and bag supplies to the nurses' homes. Use lab-in-a-box for blood work. I always say that clinicians have to think of themselves as a business and cut their expenses as the agency does.

Hi 2KM, RN Medicare surveyors make sure that you are following the conditions of participation (COPs). You agency's policies should fall in line with COPs. Make sure that there is a current med sheet in the home. Really make sure that the patient and family understand the procedure for filing a complaint about care, ie. notify the supervisor, agency administrator and finally the state home health hotline. Circle the state homehealth hotline number. Make sure you have signs posted if there is O2 and remember handwashing and bag techniques. M-care surveyors want to make sure that you are doing what the government is paying for and that you are seeing patients who are qualified for home care and that the patients are being seen as stated on the 485. They talk to the patient to get the real deal on what is going on with their care.

People in homecare know that nurses chart, eat, etc in their parked cars and stop to go to the bathroom so that's how you explain gaps. But you can't have all these paperwork-in-the-parking lot stops and yet paperwork is always late. You are by allowed by law to take a break. If the labor board ever came to audit, they need to see a break on your logs. I think we homecare nurses will keep pushing so that we can stay ahead of rush hour traffic or finish before dark. Honestly, I don't care if people know where I am because I won't be anywhere I would be embarassed about including picking the hot Christmas toy for my child at Target.

I would get an order to straight cath. The patient teaching would be the benefits of straight cath versus the other methods. If they still refuse, then you can call the doctoR for a d/c order related to the cath and add clean catch

Kate said it all. There's not much we can do for these patients.