Random
What are the dependent disciplines?
MSW
HHA
Who signs the Plan of Care (POC)?
Physician
NP
PA - under physician supervision
Chapter 7, 30.2.4
Home health recertification is required how often?
Recertification is required at least every 60 days when there is a need for continuous home health care after an initial 60-day certification.
Ch 7, 10.3
What are the independent disciplines?
PT
OT
ST
SN
The Member is 58 year old female admitted to Home Health following a recent hospital stay. 5 PT visits have been ordered to assist with gait training and to establish a home exercise program. Review of documentation shows since discharge home the Member has attended a funeral, gone to the beauty shop for a haircut, and attended her son's graduation from college. Is this Member considered homebound?
Yes.
However, occasional absences from the home for nonmedical purposes, e.g., an occasional trip to the barber, a walk around the block or a drive, attendance at a family reunion, funeral, graduation, or other infrequent or unique event would not necessitate a finding that the patient is not homebound if the absences are undertaken on an infrequent basis or are of relatively short duration and do not indicate that the patient has the capacity to obtain the health care provided outside rather than in the home
CMS Chapter 7, 30.1.1
A TEAMS message is received from Bob Smith re: patient Edwin Wells. You do not know Mr. Smith. Reject the call and contact the patient or family for permission to speak with him.
What is following HIPPA guidelines?
OASIS is completed at start of care, return of care, transfer to inpatient facility, discharge of Member from HHA and at one more point.
What is 60-day follow-up
58 year old male with a 20 year history of C6 complete spinal cord injury was recently admitted to home health following acute hospital stay related to a urinary tract infection. PLOF noted he lived with his wife who provided assistance with all activities of daily living. Currently, he is independent with directing care but physically dependent. Skilled nursing is following the Member for treatment of a Stage II decubitus ulcer. Orders for a home health aid are denied
What is considered medically necessary personal care?
Physical therapy order reads: 1W1, 2W3
What does this mean?
1x/week for 1 week
THEN
2x/week for 3 weeks
A Member with severe arteriosclerotic heart disease is admitted to Home Health because heart disease is of such severity that he must avoid all stress and physical activity.
What constitutes a considerable and taxing effort.
Chapter 7, 30.1.1
Both routine and nonroutine medical supplies are included in the base rates for every Medicare home health patient regardless of whether or not the patient requires medical supplies during the 30-day period. T/F?
True.
Chapter 7, 10.10 -B
A Member's availability of assistance for ADLs
What is M1100
For foley catheters, there must be a physician order. Where is this physician order found?
Plan of Care (POC)
SN is ordered fewer than 7 days a week
What is intermittent nursing services?
A 88 year old female has Home Health orders for skilled nursing for diabetic foot care. Documentation notes that the Member has not been recently hospitalized but was seen in her physicians office.
What is a direct referral?
Chapter 7, 30.1.1
A member has limited vision and unable to self-administer his eye drops and ointments for glaucoma. Physician has ordered SN. How do you proceed?
The administration of eye drops and ointments does not require the skills of a nurse. Therefore, the skilled nursing visits cannot be covered as skilled nursing care, notwithstanding the importance of the administration of the drops as ordered.
Chapter 7 - 40.1.2.4 B
The OASIS is a comprehensive assessment designed to collect information on nearly 100 items related to a home care recipient's demographic information, clinical status, functional status, and service needs. OASIS stands for:
Outcome and ASSessment Information Set
A Member is admitted to Home Health. SN notes that the member has a history of a colostomy, 2018, and absent from complications. Nursing documents that during the visit the colostomy bag is changed because the Member is too fatigued to change his colostomy bag. Orders for SN colostomy care are denied.
What is medically necessary colostomy care.
Chapter 7, 40.1.1
Is a member with Alzheimer's disease considered homebound?
Not always. •Early stages of disease process may not support homebound status based solely on the diagnosis code
A Member was recently admitted to Home Health following hospital stay. He has requested that skilled disciplines visit both his primary residence and his vacation beach house.
Where can a patient be seen for home health?
Chapter 7, 30.1.2
How often must each therapy discipline (PT/OT/SLP) for which services are provided have a reassessment completed?
At least every 30 days, for each therapy discipline for which services are provided (not assistant)
The Member should be functionally reassessed with clear documentation of results along with the therapist's determination of the effectiveness of therapy, or lack thereof.
The 30-day clock begins with the first therapy service (of that discipline) and the clock resets with each therapist’s visit/assessment/measurement/documentation (of that discipline)
Chapter 7, 40.2.1
The Initial Physical Therapy assessment can be performed by a Physical Therapy Assistant as long as the Physical Therapy co-signs the assessment. T/F?
False. Initial Therapy Assessment must be performed by a qualified therapist (not an assistant)
Chapter 7, 40.2.1
A physician has ordered skilled nursing care for teaching a diabetic who has recently become insulin dependent. The physician has ordered nursing teaching of self-injection and management of insulin, signs, and symptoms of insulin shock, and actions to take in emergencies.
What is medically necessary nursing diabetic education
Chapter 7, 40.1.2.3
A 58 year old Member was recently admitted to Home Health after hospital stay related to hyperglycemia. She now has insulin dependent diabetes. Prior to hospital admission she was checking her blood sugars 3 times/day with her glucometer. Now she requires Lantus to be given daily and has a sliding scale insulin for meals. Oasis notes that she has returned to work but only in a part time capacity at 10 hours/week. Previously she was working 40 hours/week. She is unwilling to inject herself that many times a day but has the logical ability to do so. Her spouse has severe arthritis and is physically unable to assist. Home Health SN services are denied.
What is the home health homebound definition?
A Member was recently admitted to Home Health following hospital stay with cardiac valve repair. He has requested that skilled disciplines visit both his primary residence and his vacation beach house. The PT initial evaluation notes that the Member's PLOF was independent and he participated in triathlons 3 times a year. Evaluation noted that he required CGA assistance when ambulating, but was notably dyspnic and needed to pace his walking. This causes a taxing effort to leave home.
What is a reason for homebound status?
Chapter 7, 30.1.2