General Clinical
Contains guidance when request is over ordered frequency.
What is MD Order Home Health?
This job aid contains a information to process a service line if part of the visits were performed on or before the standard five business day rule (verified per documentation).
What is Retro?
This is the number of most problematic wounds you include in your wound review note.
You would use this job aid if you send an adverse fax because you need to escalate to physician review. You have all the clinical information and made no outreach.
What is Outreach for Orders/Additional Information JA?
This contains guidance to help a caller with portal issues or when to transfer to Clinical Solutions.
What is Call Scenarios/Transfer job aid?
This job aid provides guidance with a script to approve visits based on information provided. Additional visits can be requested along with updated OASIS, 485, visit notes, etc.
You locate Crisis Call information here.
This job aid has guidance for phone and fax outreach.
What is Outreach for Orders and Additional Information?
An authorization representative from Disney Home Health calls asking to withdrawal a SN SL request.
The wound is 100% epithelialized. You outreach for this (one call) when the date is missing in your wound documentation note?
TAT day 4 or greater on a Monday or Tuesday follows this outreach process.
After outreaching for skilled nurse visit notes, your call was unsuccessful. This job aid directs you to send a fax template and in your documentation to select "Attempt 2."
What is Outreach for Orders and Additional information?
A service provider becomes hostile on a call, you are unable to de-escalate. You will use this resource for guidance.
Agency requested 20 initial SN visits. The discharge summary only indicates a stage 2 pressure injury with no further wound information. You left a voicemail and then faxed the agency. You wait this number of hours for a return call before escalating the service line?
What is 24 hours? (DOV JA)
You can find guidance here if you have an episodic OON HMO and there is no staffing note for the certification period.
What is the Episodic job aid?
Within this job aid, a MSW evaluation or recommendation is completed before referring to the health plan case manager.
This resource contains the following guidance: "Approve one visit per discipline that was previously in the home with ROC orders."
What is C3 IV Process and Reviewing IVs (JA). _____________________________________
Located in MS Teams and Specialty Services-C3