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. You do not know Mr. Smith. You hover over the name and it says he is a Customer Service Coordinator. Mr. Smith says, "Hello, hope all is well, I see that your name is on this Auth # 111122021873123. The SL is in your queue. I have Kim on the line and she would like to speak with the reviewer. How do you proceed?
Who is Kim? If coming from Customer Service Coordinator then it's likely HHA (or member, family member, physician, etc). You request that Mr. Smith transfers the call to the Clinical Solutions Team.
OASIS is completed at start of care, return of care, transfer to inpatient facility, discharge of Member from HHA and what?
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. Order for 5 HHA visits has been received. How do you proceed?
HHA are not medically necessary.
However, where a family member or other person is or will be providing services that adequately meet the patient's needs, it would not be reasonable and necessary for HHA personnel to furnish such services.
Ch 7, 20.2
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 and leaving home requires a considerable and taxing effort. Does this Member meet Homebound criteria?
Yes, because Member has a medical condition such that leaving his home is medically contraindicated AND requires 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
How do you quickly find a Member's living situation & availability of assistance on the OASIS?
CTRL F and search: M1100
For foley catheters, there must be a physician order. Where is this physician order found?
Plan of Care (POC)
SN must be considered intermittent which is defined as fewer than 7 days a week OR what?
Fewer than 8 hours each day, for period of 21 days or less
A 88 year old female is admitted to Home Health for skilled nursing for diabetic foot care. Documentation notes that the Member has not been recently hospitalized. She was admitted directly from her Physician's office. Documentation notes she does not often travel from home because of she is worried that she will fall. Is the Member considered homebound?
No. The aged person who does not often travel from home because of frailty and insecurity brought on by advanced age would not be considered confined to the home for purposes of receiving home health services unless otherwise supported (recent surgery, recent hospital stay with weakness, severe medical disease where physical stress of leaving home is medically contraindicated, etc).
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 to change his colostomy bag. Is this a skilled nursing need?
No.
A patient with a well-established colostomy absent complications may require assistance changing the colostomy bag because they cannot do it themselves and there is no one else to change the bag. Notwithstanding the need for the routine colostomy care, changing the colostomy bag does not become a skilled nursing service when the nurse provides it
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. Is this Member considered Homebound?
Yes. Member may have more than one home and the Medicare rules do not prohibit a patient from having one or more places of residence.
For example, a person may reside in a principal home and also a second vacation home, mobile home, or the home of a caretaker relative. The fact that the patient resides in more than one home and, as a result, must transit from one to the other, is not in itself, an indication that the patient is not homebound.
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 teaching of self-injection and management of insulin, signs, and symptoms of insulin shock, and actions to take in emergencies. Is this is a skilled need?
Yes. The education is reasonable and necessary to the treatment of the illness or injury.
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. Her spouse is has severe arthritis and is physically unable to assist. Home Health SN has been ordered for medication MMTA. How do you proceed?
Member is not homebound. Therefore, home health services cannot be approved.
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. 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 on the beach. He also required CGA with aquatic therapy in his pool and was only able to swim freestyle for 10 minutes before needing to stop. Is this Member considered Homebound?
No.
Can have multiple places of residence BUT must be homebound
Chapter 7, 30.1.2