KLQ727

Bought my daughters the Garmin Nuvi 200W for Christmas. No bells and whistles...just navigation. Very good price and they work really well. I have built-in GPS in my car and think theirs works even better! However....don't go to Circuit City...they advertise the 200 as the widescreen, but it's not. Make sure the box says 200W....the widescreen gives you a better map. ~Kathy

You may contact the physician and obtain orders. You may also suggest the patient contact the doctor and ask him to call you. Or tell his nurse that you will be calling for orders per their request to have your agancy. Either way is ok.

check out some of the suggestions at this site http://nursing.about.com/od/nursingsoftware/f/pdasoftware.htm

If you're setting up an intermittent visits - home health care company as opposed to providing private duty shift care in the home.... Reimbursement under medicare (PPS) basically is now based on an episode payment. In a quick nut shell... (and it's way more complex than this!!!) Doctor gives you a referral.... Nurse makes 1st visit and fills out the OASIS (PPS document with MANY questions). Based on the answers to these questions which include the primary skilled care diagnosis for the home care visits, and many answers about the patient's abilities to care for himself, you will receive a specific rate for reimbursement for a 60 day episode of care. (The answers are numerically weighted and add up to a HHRG which equates to a dollar amount for your geographic location.) This reimbursement comes in 2 lump sum payments, and covers ALL (visits) care you provide for that patient (Nurse, Aide, MSW, PT, OT,ST) for the 60 day period. In several instances, it also covers any supplies such as dressings, ostomy supplies, etc. that you provide for the patient. Medicare no longer pays per each visit made. (Yes, there is an exception...if you make less than 5 visits they will pay for each visit.) But say you have a patient who needs to be seen daily....they can lose money for you....but the catch 22 is you have to accept some of them or risk being banned from accepting medicare payments. Each case will be different. Some patients can conceiveably make you a profit, and others will possibly eat up the profits. Home health is a rewarding industry, but you won't get rich in $$$$. For more information see: http://housecalls-online.com http://homehealth101.com Hope this helps.

Melissa, You can use information found on my sites: http://homehealth101.com http://housecalls-online.com (Please be sure to give credit to any of your sources and authors.) or you can PM me. Kathy Quan RN BSN PHN

here's a couple of websites also: http://housecalls-online.com http://homehealth101.com Hope this helps

I'll let you all in on a little secret.... you really USE this process in Home Health Nursing and eveloping a plan of care for your patient. And I agree whole heartedly with the person who wrote that this helps you to develop critical thinking skills!!! An essential qualification for becoming a great nurse in any field. Go to your local book store or nursing library and find home health related books by Robyn Rice and T.M. Marelli. These women show you how to take a patient's medical diagnosis and develop a nursing plan for their care in the home. With a little adaptation, you can make it work for any nursing environment. They show you how to look at the WHOLE patient, not just the task you are providing such as a dressing change. That's what nursing process is all about. The whole person is affected by, and affects the medical diagnosis. When you can see the practical application of the process, it helps tremendously in understanding all those texts that are basically written at and for PHd level nurses. Nothing wrong with them, but I struggled with this whole business 30+ years ago, and not until I got into home health and read these other books and used them as my "bible" for years, did I really feel I "got it" completely. Hope this helps!

This is a hotly debated item in our industry. There are a couple of list serves run by the Home Health Line group and this discussion is a constant factor. You may want to check these out if you need more data than you might acquire here. (PM me if you need info) I am an RN BSN PHN with over 27 years experience in home health. Currently, my job is QI coordinator for a for-profit HHA. The major component of my job is to review the OASIS data and code it with ICD9 codes. My experience is and has been (in this company at least) that our field staff can barely tell you what their primary focus is with the patient, much less code it correctly. Whatever the intake staff put on the referral as a diagnosis, is what comes back to me on the OASIS. In a couple of instances, the LVN intake person misunderstood what she heard and wrote down a phoenetically spelled diagnosis. It came back to me spelled exactly that way on the OASIS. (And in one instance was not the diagnosis at all.) If she put down supercalfragalisticexpialidocious it would be regurgitated by some staff. Some actually do have a clue, but still can't code it. It amazes me that some agencies do find sufficient field staff to provide quality care, and to code accurately as well. And I'm in a large metropolitan area (Los Angeles)! We don't invest a lot of time (minimal actually) in mandatory meetings, and staff education. Other places I have worked under PPS have done a lot of staff development, and it makes a big difference. However, they had QI dept. code the OASIS as well. In all fairness, however, it's a very difficult task to code. If I were a field nurse again, I wouldn't want to be coding my paperwork. I would feel obliged to provide quality care to my patient, and resentful of the time taken away to code. I feel strongly that is as it should be. Field staff should be field staff and not coders, and billers, and insurance verifiers. Hope this helps. Kathy Quan RN BSN PHN:)

Yes, that's true. There must be a diagnosis of trauma/burn to get the HHRG points. However, one point that many nurses forget is that on M0450... once a decub always a decub (unless grafted) and unless it's an open or troublesome decub they don't say yes. Say, for instance, you had a patient on for decub care in January and now again in July they have new ones.... don't forget to count the old ones in the numbers of decubs especially if they were/are stage III or IV. And be sure to carry these same numbers through on all of your OASIS documents for that admission.... our staff tend to let them drop off at recert time.

Our agency is JCAHO also, but it wasn't JCAHO who required the order for the missed visits. It was a Medicare Survey that dinged us for not having MD orders for missed visits. Documentation in the chart was needed to explain why the visit was missed, but needed the MD order to show that he/she was informed of, and approved a change in the plan of care. Their reasoning was that ANY change in the plan of care has to be ordered by the MD. Just the same as any treatment does. Makes sense... that's the rule, but we all get used to actually doing just a phone call or log, etc. Had we originally written on the 485, for example, 2w4 except for weeks when seen by MD (may make 1 visit only) then we only needed to make a note in the chart. However, if the reason for the missed visit was not for an MD visit, we still needed an order.

Look on my site http://housecalls-online.com on the Resources page. A very comprehensive form is posted there. Others are coming in and I'll post them as well. On the Links page, you'll find a link to HHAresources for Jared Nunez' page. He has posted a couple of forms there as well. Hope they are helpful. My agency uses one similar to the one on my site, but far less complex. Pick and choose a few of each group of questions and I think you'll have a great tool. Let me know what you come up with and if you're willing to share, send me a copy to post. Thanks, Kathy QUan RN BSN, QI coordinator:cool:

If you can get them to pay for one of Nancy McGuirre's upcoming V-code tele-conferences, it's well worth the $$$ and you can have as many people as you want listening in for the one fee. I had no "formal" training just what I had picked up over the years from others in the QI role while I was a clinical supervisor. Have "attended" 2 of these teleconferences each Septmeber now and they have been great. At Myhomehealth.com they have the info on her next teleconference. I think it's actually to be 3 of them. My company won't foot that bill, but I think it would be worthwhile. I've been in your shoes with being the new hire and having more and more thrust on me, and it's not fun!!!!!! Hopefully something in the "trade off" makes it worth it at least for awhile until you can have time to search out something else. I think the V codes are finally beginning to make sense to me. I do all the coding.... our staff of princesses will NEVER understand it, and we'd go absolutely BROKE if we had to depend on them to figure out a reimbursible code, much less a diagnosis for what they're doing.... or what SKILL they're actually providing!!!! Sorry..... had to vent.... been one of those days.... and the staff are the ones making the $$$$$. I really think I'm going to set up a fee system for all the stuff I have to do for them. There are some helpful V code cheat sheets posted on my website..... I use them all the time, and bless the contributors every day!. http://housecalls-online.com If anyone reading has any others to share please let me know. Hang in there, and email me if you have specific QI questions.... I'll give it my best shot for you. [email protected]

I love your site and will place a link to it from mine. We all have the same idea, and networking is how we'll all survive! and hopefully retain some sanity. Yes, please add alink to my site on yours as well. Thanks.... and thanks for all of your efforst in your site! Kathy

Hello, I just found this forum today. I work as a QI analyst in a home care agency in California. I also publish my own website designed to share ideas with other home health professionals. Recently I received 3 V code cheat sheets from peers and have posted them on my website on the RESOURCES page. You can print them from the site, or email them to yourself so that you have an electronic copy that you can incorporate into your own documents. They have been very helpful to me in my job as the so-called coding expert. Check them out and if you have copyright free documents to share.... such as QI audits that I also see others here looking for .... contact me abouut posting them to share. Hope this is helpful! ~ Kathy http://housecalls-online.com