Variety
Integumentary
ADL's M-1800's
Skilled Need
Medications M-2000's
100
Federal Regulations that govern the Medicare Home health program and provide guidelines for agency management, personnel, and patient care. When state licensure surveyors perform annual visits, they look for compliance in this.
What are Conditions of Participation (CoP)?
100
The patient has an extensive stage 4 pressure ulcer and she is receiving daily wound care for two weeks. A nurse goes out on Sunday for wound care. The nurse should do the following.
What is measure the wound?
100
Scenario: Mrs. Watson usually wears a bra, an undershirt, a blouse, and a sweater. You are ordered to teach her how to apply her neck brace during the SOC visit. Due to her severe neck pain and advanced arthritis, you observe she can't help at all putting on her neck brace. and needs some assistance to put on all the remaining clothing items.
What would be the Correct M1810 Response?
What is 2- Someone must help the patient put on upper body clothing.
100
71 yr old female has history of COPD, legally blind, and venous insufficiency. Patient is unable to tend to wounds and lives in ALF (Assisted Living Facility) with caregivers unable and unwilling to do wound care. Patient was noted to have a fluid filled blister that was draining. The nurse frequency was twice weekly for two weeks. The wound care treatment initiated was as follows: Cleanse with NS, pat dry, apply non-adherent oil emulsion dressing, gauze, wrap with kerlix and secure with tape. The G-code (service type) was labeled as RN skilled routine visit. This patient is or is not appropriate to remain on service because they have ____________
What is skilled need?
100
During the discharge assessment visit, the RN reviews the patient’s medication list and confirms that no potential clinically significant medication issues are present. In reviewing the clinical record, there is documentation that a drug regimen review was conducted earlier in the episode, and no potential clinically significant medication issues were identified. There is no other documentation to indicate that potential clinically significant medication issues occurred during the episode of care. How would you answer M2005 Medication Intervention?
What is 9- NA There were no potential clinically significant medication issues identified since SOC/ROC or patient is not taking any medications.
200
When admitting the patient to home health services, the patient/client has selected someone such as a neighbor or has appointed someone such as a DPOA (durable power of attorney) or guardian to make decisions related to the patient's healthcare or well-being.
What is a Legal Representative or Representative?
200
At the ROC assessment, the RN noted Mr. Smith had only one pressure ulcer and it was on his right hip. It was completely covered with yellow, stringy slough. She had cared for Mr. Smith for six weeks before he was transferred to the hospital and clearly remember it was a Stage 4 pressure ulcer with exposed muscle, although at this time she cannot see any identifying Stage 4 structures.
How would M1320 Status of Most Problematic Pressure Ulcer that is Observable be answered
(M-1320) What is 3-Not healing
200
Scenario: When Mr. Green was admitted, he needed supervision at all times to ambulate safely. At Discharge, he walks safely and independently with a cane and only needs help from someone when he is walking on uneven surfaces.
What would be the correct M1860 Response at SOC & DISCHARGE?
What is 3-Able to walk only with the supervision or assistance of another person at all times for SOC.
What is 2- Requires use of a two-handed device (for example, cane, single crutch, hemi-walker) to walk alone on a level surface and/or requires human supervision or assistance to negotiate stairs or steps or uneven surfaces at Discharge
200
Scenario: 35 yr old male was admitted and assessed for s/p placement of plaster cast due to a fracture of the femur. Patient has a pre-existing condition of peripheral vascular disease to the extremities. The nurse will need to observe for complications, monitor for medication administration for pain control and teach proper skin care to preserve skin integrity and prevent skin breakdown. The patient will also be receiving an RPT and OT evaluation. This patient is/ is not appropriate to remain on home health service because they have ____________
What is skilled need?
Rationale: The clinical notes for each home health visit should document the patient’s skin and circulatory examination as well as the patient and/or caregiver application of the educational principles taught since the last visit. The plan for the next visit should describe the skilled services continuing to be required
200
Scenario: During the SOC visit on Tuesday, the RN conducts a drug regimen review and identifies that medications have been ordered by several different physicians. Mrs. Adams is also taking several herbal supplements and reports that she is unsure if her physician is aware that she takes them. After completing the Drug Regimen Review, the RN also discovers some potential contraindications that she believes need timely physician notification, and calls the physician from the home. She reports the use of herbal supplements and asks for review and approval of the current medications list. The physician's office called the nurse back on Thursday with orders approving the current medication list and herbal supplements. The RN them called Mrs. Adams and reported that she was to continue taking her medication and herbal supplements according to her list as she has been taking them and confirmed that Mrs. Adams understood the instructions. Answer the following questions.
What is 1- Yes-Issues found during review for M2001
What is 0- No for M2003
300
If a patient has verbalized that they have a Legal Representative that lives in Florida and wants them involved in their care, how many visits do you have to give VERBAL notice to the Legal Rep? How many days to give WRITTEN Notice? What are the means by which the Legal Representative can receive written notice?
What are 2 days for verbal notice?
What are 4 business days of the initial eval visit?
What are e-mail, mail, fax?
300
Mr. Lee had a Stage 2 at SOC that was healed at discharge. He also had an unstageable pressure ulcer at SOC that was debrided and reported as a Stage 3 mid-episode, and was observed as a Stage 3 at DISCHARGE. There are no hospitalization during the episode.
How would you answer M1311 at Discharge?
How do you answer (M-1311) Current Number of Unhealed Pressure Ulcers at Each Stage.
What is A1.-0, A2.- Blank;
B1.- 1 and B2.-1;
E1.-0, E2.-Blank
300
Scenario: When Ms. Louise 74 yr old female was admitted, she was observed to be laying in bed and was only able to tolerate being in a wheelchair for short period of time. She has some arthritis in her hands that made it difficult to wheel herself, she was only able to be in a wheelchair when going to M.D. appointments but spent the majority of her time in bed.
How would you answer M1860 ?
What is 5-Chairfast, unable to ambulate and is unable to wheel self.
300
Scenario: A 54 yr old male named Carl was discharged from the hospital with an open draining wound that requires irrigation, packing, and dressing twice each day. The agency has taught the family to perform the dressing changes. The agency continues to see the patient for the wound care that is needed during the time that the family is not available and willing to provide the dressing changes. This patient is/is not appropriate to remain on service because of their ____________.
What is skilled need?
Rationale: The wound care continues to be skilled nursing care, notwithstanding, that the family provides it part of the time, and may be covered as long as the patient requires it.
300
Scenario: During the SOC assessment, the RN completes the drug regimen review and notes medication discrepancies. The patient's list of medications from the inpatient facility includes warfarin. The patient's in-home medication list includes aspirin. the patient states that she intends to take both warfarin and aspirin, however reports that she has been experiencing nosebleeds. The RN determines this to be a potential clinically significant medication issue.
The patient also states that she does not take any over-the counter or herbal medications. On the day of admission, the RN calls and leave a message with the physician's office related to the medication issue. The physician calls back 2 days later giving an order of no changes to the medication list. No other medication issues arise during the episode, and the patient is discharged from the home health.
How will you answer M2005 at DISCHARGE?
What is Response 0-No.
400
Patient and Legal Representative (if any) receive the following upon initial evaluation visit: Written Notice of R&R, Agency Transfer and Discharge Policy, Administrator's information to file a complaint, Oasis Privacy Notice. All of this is called?
What are Notice of Rights or Patient Right?
400
Mr. Pierce has two pressure ulcers. A Stage 3 ulcer on his trochanter has been healing quickly and is currently fully granulated. He also has a pressure ulcer on his elbow that is a Stage 2. The ulcer is at risk for worsening, as Mr. Pierce forgets to use pressure relief strategies.
What would be the Correct M1320 Response?
What is 3-Not Healing?
400
Scenario continued: Mr. Lee 76 yr old male is being discharged from the agency because he is going to outpatient rehab. He is observed by the therapist that patient has improved greatly, is now utilizing his FWW around the home but is unable to use it when entering or exiting the home because of the steps at the entrance. The therapist also notices a little of impaired balance even when utilizing the FWW.
How would you answer M1860 upon DISCHARGE?
What is 3-Able to walk only with the supervision or assistance of another person at all times.
400
68 yr old Camille has multiple sclerosis, fibromyalgia and rheumatoid arthritis. Patient is unable to get out of bed without assistance and is receiving physical therapy for gait strengthening. She has a caregiver who comes twice weekly to assist with household chores. She does not have a diagnosis of constipation. Patient calls the triage nurse stating she has not had a bowel movement in 2 days and would like a nurse visit to give her an enema. This patient is/is not appropriate to receive a visit because ____________.
What is not a skilled need?
Rationale: If a patient has a condition such as irritable bowel syndrome or is recovering from rectal surgery, may be such that he or she can be given an enema safely and effectively only by a nurse. If the enema were necessary to treat the illness or injury, then the visit would be covered as a skilled nursing visit.
400
Mr. Smith is a 78 yr old male who is being discharged by the RN.The RN reviews the clinical record and notes that patient had a potential clinically significant medication issue that occurred at the SOC. In reviewing the EMR (electronic medical record) the nurse notices that the admitting clinician called the physician the same day. The physician call the nurse by midnight the next day with orders and instructions for the patient. How would you answer M2001 and M2003?
What is 1, Yes-Issues found during review for M2001
What is 1, Yes response for M2003
500
When doing the Initial Evaluation (SOC) you notice that the patient verbalizes the following: "I would like only a female nurse," The patient also adds that he is knowledgeable in his medication and documents everything, and lastly he mentions he would like to be able to "get in and out of the shower by myself." The above responses are documented in the clinical note.
What are Preferences, Strengths and Patient Centered Goals
500
Mr. Adams had a cholecystectomy performed via laparoscopic surgery 10 days ago and is being admitted to home care following exacerbation of his CHF post-op. His 1 cm incisions was closed with a chemical bonding agency and is assessed to be completedly closed, clean and dry with no signs of infection. Additionally, Mr. Adams has an implanted Baclofen infusion pump and the puncture site where the reservoir was filled in the hospital is reddened and tender.
Select the correct response for M1342 Status of Most Problematic Surgical Wound that is Observable.
What is 3-Not healing?
500
Scenario: Mr. Baker is 72 yrs old and has been referred to home health services for s/p ORIF of the right hip. Initial visit is being made by the RN. During the OASIS walk, she notices that Mr. Baker is unable to transfer to the toilet, but verbalizes that he was using the BSC in the hospital 3 days prior to discharge. Patient has no BSC (bedside commode) and there is no bedpan in the home.
Your Response to M1840 is?
What is 4-Is totally dependent in toileting?
500
The patient is a 75 yr old male who was in the hospital with a dx of Severe Aortic Valve Stenosis and is s/p CABG x1. Patient with medical history of: CAD, HTN, DM, chronic A-fib with pacemaker and staph infection. An RN admitted the patient for home health for PT/INR blood draw, evaluation of cardiopulmonary status, incisional care and medication assessment. The RN instructed on bleeding precautions, incisional care and medications. The nurse documents that patient verbalizes understanding. In a follow up visit 2 days later another nurse goes out makes the visit assess the incision and instructs on incisional care, bleeding precautions, taking the medications as instructed. No orders from physician to draw PT/INR and no incisional care made. The second visit made my the following nurse is/is not considered appropriate because __________.
What is not a skilled need?
Rationale: The patient verbalized understanding of incisional care, bleeding precautions, taking medications as instructed by the 1st clinician. The 2nd clinician is educating on the same thing the 1st clinician educated on. Medicare will deny payment because the Skilled nursing services were not medically necessary.
500
Mr. Smith is a 78 yr old male who is being discharged by the RN. The RN reviews the clinical record and notes that patient had a potential clinically significant medication issue that occurred at the SOC. In reviewing the EMR (electronic medical record) the nurse notices that the admitting clinician called the physician the same day. The physician call the nurse by midnight the next day with orders and instructions for the patient. During the certification period, the patient ended up in the hospital and orders were received to do and ROC. When doing a drug regimen review the nurse notes a clinical significant medication issue, she calls the physician while in the patient's home. The physician returns the RN's call 2 days after the ROC is done with orders to resolve the clinically significant medication issue and instructions are given to the patient. Now, that the patient is being discharged. How would you answer M2005?
What is 0-No.