Reimbursement and homebound status

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Hi everyone!

I've new to home health nursing, only been on my own for about a month. I've been running into the same problem over and over. I get to a pt's home to do an admission and they are not homebound. I still spend close to an hour there, assessing, teaching etc. and then still have to do OASIS and all the other paperwork...even if they have private insurance. My question is, will Medicare/medicaid reimburse for the initial visit when the pt is NOT homebound or does the pt get a fat bill in the mail?

Does everyone else find all of this insurance/reimbursement issue to be complicated or is it just me? Why can't the "homebound" status be determined before the agency wastes nursing hours? Is it the fault of the intake staff?

Thanks in advance for the help!

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Specializes in LTC/hospital, home health (VNA).

if you dont admit due to not homebound - you cant bill for visit at all - we consider it a free visit. it would be WONDERFUL if the referring docs/facilities would learn what it is that we do...that we need a skilled service and them to be homebound. would definitely make our jobs lot easier!!! Dont really have an answer on how to cut back on those wasted visits...would be nice to have some kind of black and white questionare to ask at time of referrals to help rule out those not homebound...rather than people just jotting down the demographics. doesnt matter what the insurance is if you cant bill them! sorry...started to rant a little there:)

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Just the other day some co-workers and I were discussing this very issue.

We feel it's a screening issue in the office. When it happens, we call the DON and it becomes a non-admit visit. We still get paid, but the company doesn't bill. We allso tell the sales team so they can use it to educate the MD's.

You'd think since the company doesn't make any money and still pays us, it would be better screened in the office, but they still get by. I also try to screen when I call to arrange the apt time to do the visit. If they say something like "we are going to the movies this afternoon" ---usually they aren't a canidate for HH services.

Funny how we all have the same complaints......

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Good companies will pay you for nonadmit cases and the rest will not. One of the companies I currently work for has an unwritten, unspoken code. It is:

Go out there and get the patient, any patient and admit the person whether they qualify for home care or not. If you don't we will dump you for another nurse.

They treat their nurses like prostitutes.

I am currently working for a company that sent me to open 4 cases last week. None were homebound, and 2 were not even home for their scheduled appointments. The other company I work for sent me to visit a person who wanted me to "hurry up, I have to go to work." This is horrifying.

Last week in 1 day I put 250 miles on my car and made Zero Dollars because the agency will not pay if the patient is not admitted. That was the day of despair, the day I decided to find a decent company to work for.

So....guess how many not homebound patients they have admitted into their agency - lots, over 50% at least. Most nurses admit them because they need to pay their bills and eat, not to mention all the driving expenses.

Then there are the other type of cases. They appear to be homebound and know what to say to get admitted and then cancel service or end up with lots of missed visits (translated into no income for the nurse).

In some areas there are too many agencies and too few patients, so they just pick up any junk referral they can.

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I found out that one of my current employers does not pay "show up" pay when I submitted my paperwork for a visit where the client refused services and it didn't show up on my paycheck. When I asked about it I was treated as if I was out in left field. Yes, I drove more than 52 miles for nothing for that one.

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Specializes in LTC/hospital, home health (VNA).

that really stinks...I am salaried, so while that occasionally works against me - it does not affect whether or not I admit or not. My agency is pretty good about us not admitting due to not being homebound.

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Specializes in Hemodialysis, Home Health.

Wow.. I'm really blown away reading all this. :bugeyes:

I can't believe agencies sign up pts knowing full well they are NOT homebound. :nono:

They are asking for trouble, and it is fraud, plain and simple.

Our agency is wonderful ... if we get there, start the assessment/admission and find they are NOT homebound nor willing to BE temporarily homebound, we explain the requirements to them, and then move on. Agency always pays us for our time and travel.. it's only happened to me once or twice over the years, but I've always been paid for the visit.. and my miles.

Most of our patients are only too glad to see us.. we have the occasional "have to get my hair done today", but for the most part, our patients are truly homebound and love to see us come. If we find they are not homebound after all, or soon are to be no longer homebound, we explain the medicare requirements and plan on discharging.

Wow.. I'm reading some amazing.. and truthfully, some quite disappointing and troublesome things here about how other agencies do things and push that envelope. :uhoh21:

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I will say that what some of you have posted just makes me ill. I do want you to know that there are GOOD people out there to work for. Yes, everyone has some problems, but what you guys have described is FRAUD. And in the end, it OUR hard earned tax dollars that are being wrongly spent.

I don't like to shake things up, but I would seriously consider calling the state.

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