"medicare" charting

[kgarfield2000]

hello, I am currently working for 2 agencies. at agency #2 i am becoming increasingly frustrated at the level of detail that everything is reviewed and sent back to me for correction. most of this stuff, to me at least, is trivial and boils down to wording mostly. one issue, among many, is the documentation of skin color...when i am dealing with an ethnic patient, they are stating that "wnl for ethnic background" is unacceptable and they want me to write "pink" or they are actually changing my notes to state "pink." i have questioned them about writing this when i have an african american patient, as in their case, pink would be a bad thing...yes, i have a problem with them changing my notes, but i also would like to figure out what medicare states so i can have an intelligent conversation and not go in circles with them. i have actually discussed my issues with the DON at agency #1 and she tells me that their pettiness is unnecessary for medicare compliance. when i attempt to discuss my concerns with agency #2, the only answer i get is "that's medicare's requirement" do you know if there is somewhere i can look to see what medicare actually states to verify this and other charting problems i am having? i have tried looking on the official medicare website, but this is all patient information...is there a site for healthcare professionals?

[caliotter3]

About the "pink" skin: I looked this up one time and started using the word "normal" because that was what was written in a textbook on physical assessment. My client at the time was Latino with nicely brown skin, not pink. Now my agency just changed to a form that gives "pink" in a checkbox, so I've been checking "pink", but will start writing in a word, since "pink" is not the patient's skin color. I think the agency personnel are acting strange. They are blowing smoke about "medicare requirements", rest assured. Perhaps you can start spending more time with the agency that makes sense.

[KateRN1]

The important things are to document homebound status, medical necessity of home care, your billable skill, and what follow up is required. There is no requirement--anywhere--that you document a patient's skin as being pink. There is a lot of nit-pickiness to wording for reimbursement, but that ain't one of 'em. I have a packet of handouts for home care documentation that I am happy to share. Email me at KateRN1 at hotmail dot com and I will be happy to send to you.

Ask the agency for the CMS guideline that states the skin must be documented as pink. That oughta fix 'em.

[caliotter3]

Pink and moist would refer to mucous membranes but not the external skin, unless, of course, the person really has a pink tone to their skin.