TejasRN

LVN visits at $20 per visits is LOW!! The Houston agencies I have worked at paid $40 for LVN's, $50 for RN's. But your mileage reimbursement is where you are really getting screwed. There are a lot of agencies that pay mileage for per visit employees, which I think is like 44 cent a mile. If they don't pay you need to add all you mileage and take it as a tax deduction at the end of the year. With them giving you $2 extra a visit I don't know if that screws up you being able to deduct the miles on your taxes. I worked for a corporate Home Health company that pays their RN's $67.50 a visit for a SOC, trust me I would never take that rate. Couldn't hire any nurses that would stay. The owner of the company I work for now said" I usually pay $100 for a SOC but the nurses say Oasis C is more work, how much more do YOU think I should pay?" Plus a car to drive while you do visits, only likes to hire full time people, no one stressing in the office and I haven't even heard what the productivity is. I guess what I'm saying is it pays to talk to everyone you know to find out rates and how the company is to work for. There is a lot of variability and there are actually some good agency owners out there. I never stayed at a job that sucked!!

Reality vs Medicare Rules and Regs = Home Health can be a big pain in the butt! Meddicare does not deny visits, Medicare is your payer, you get denied payment if your episode is not billable for whatever reason, IF the Medicare contracted auditor audits the episode. In Texas we are also licensed by the state. The state survey is where you have problems with issues like no verbal start of care orders, lack of communication with the MD, lack of supervision of HHA, LVN's, no skilled visit and whatever else they can dig up. It is difficult to get initial orders but it is a requirement. Some say the signed 485 is the order but it's really not. You may get a surveyor who doesn't make a federal case of it, which is nice!

You must call the MD after the initial assessment to get verbal orders. Most often it's given by the office staff. So I put V.O. Dr.Smith/Nancy Nurse RN/my name, date and time. If you are having a hard time getting orders that's what your Clinical Supervisor is there for. State surveyors want to see evidence of this when they visit. You also need a verbal order for physical therapy plans of care. You just can't order it for the patient. Even if you get an order for a PT eval on the initial referral, the order is for an eval only. Cover you butt our surveyors here in Texas are brutal, don't ever back date anything it's considered fraud.