Barriers to DC statement
Good or Bad
Barriers to D/C: Member continues to require oversight and monitoring for diabetes, hypoglycemic/hypoglycemic blood sugar readings, and healing surgical wounds with blisters.
What is a Good Barrier to DC?
Accurate or Inaccurate documentation for this section
Patient lives at home with her daughter in single-story home with 5 STE. New medication was added to the plan of care including Lisinopril (7/22/2022) and Atorvastatin (8/18/2022) for high blood pressure.
What is inaccurate documentation?
A conversation between a naviHealth Medical Director and the ordering Practitioner to discuss if skilled needs are medically necessary.
What is a Peer 2 Peer?
The following statement is documented in what location of nH Coordinate when HHCC has changed/corrected information within the Clinical Note? For Auth XXXXXXX (nH Auth number on back page to the right of auth header), the information within the Clinical Note was changed/corrected to reflect the actual clinical documentation received from the provider to support the request.
What is comments folder?
Who completes a 3rd additional clinical requests and where can I find the information on completing this process?
What is HHCC and The Medical Director Review for Home Health Reference guide?
Good or Bad
Barriers to DC: Inability to ambulate household distances, caregiver undergoing training for transfers, ambulation, and self-care; non-healing surgical wound right foot requiring monitoring.
What is a Good Barrier to DC?
Accurate or Inaccurate documentation for this section
Relevant PMH include HTN, CAD, and neuropathy,
What is inaccurate documentation
After completing an additional service review, the HHCC determines the patient does not appear to meet CMS chapter 7 for 1/3 disciplines requested, what process does this trigger?
What is an IDN?
Where would you document wound measurements?
What is the medical Tab?
If I accidentally x the case from the team queue, how can I get it back?
What is Go to your search history, access the back page, and send it back into the queue?
If it has been several days, reach out to your CTM
Good or Bad
Barriers to D/C: Barriers to discharge include the need for wound care.
What is a Bad barrier to D/C?
True or False
This section is used to provide a summary of the patient
What is False?
That is the clinical impression
How many attempts are made for NOMNC retrieval?
What is 3 attempts?
Spoke with Ronnie CM who confirmed that the patient DC on 8/31/2022
What is the administrative communications in the engagement tab
Can visits not used in a certification period be carried over to the next certification period?
What is No, there is no carryover of visits?
Good or Bad
Barriers to D/C: Patient's CLOF is below PLOF
What is a Bad barrier to DC?
True or False
This section includes information about the current episode of care, as well as relevant information about the patient's prior level of function and living settings
What is False?
The Clinical Summary tab includes all of this information information about the current episode of care, as well as relevant information about the patient's prior level of function and living settings
Once a NOMNC is received, it is essential that the HHCC completes what process?
What is a NOMNC validation?
Patient is an 82 year old female being seen by home health following hospital discharge on 07/20/2022 for R side hemiplegia secondary to probable microvascular ischemic changes with no infarct indicated.
SOC: 07/26/2022.
What is the Current Problem?
Can I give the Provider/Agency my PureCloud extension # so they can easily reach me when confirming if they have additional information/clinicals before sending the auth to MD for NOMNC review?
What is No, You can provide your first name and last initial
Good or Bad
Barriers to D/C: Patient requires wound care 3x/week - patient unable to access the wound and does not have a caregiver to provide training to.
What is a good barrier to D/C?
True or False
This section should include the reason for acute admission, level of care change, or problem at home. Including SOC, ROC, Weightbearing status
What is True?
When sending a case to the MD to review, it is essential that the HHCC_________ for the same HHCC to continue communication with the MD.
What is assign yourself to care team?
85-year-old female discharged from hospital on 05/20/2022 for R side hemiplegia secondary to probable microvascular ischemic changes with no infarct indicated. PMH includes COPD, cancer, CAD, HTN, DM. Patient has been receiving PT and OT home health services with SOC on 08/26/2022. Request for additional OT services on 8/30/22. Patient appears to continue to meet CMS Chapter 7 criteria for intermittent skilled occupational therapy needs for R sided hemiplegia affecting patient's ability to safely ambulate inside and transfer independently. Patient/caregiver education on ADL's and transfers continues. Patient remains active in therapy sessions. Teach back continues. Patient has made progress since SOC with toileting, transfers, and ADL's. Patient continues to be homebound due to requiring a walker and/or wheelchair, assistance of another person to safely leave the home, with considerable taxing effort due to fall risk and unsteady gait. Discharge plan is to remain home with family support throughout the day. Barriers to discharge include continued assistance needed with mobility, transfers, and ADL's compared to prior level of function of independent without an assistive device needed. InterQual recommendation supports OT as medically necessary.
What is the clinical impression?
You receive an ASR for add-on MSW, what is the next step(s) before reviewing the auth?
What is verify if their is still at least 1 skilled discipline providing services?