Many homebound patients are at high risk for infection because of drug therapy and diseases that weaken the immune system, invasive devices such as feeding tubes or catheters, extreme age, and more.  It is possible that a homecare worker’s artificial fingernails could spread infection to these patients...

 

Homecare agencies have been responsible for supplies under the consolidated billing provision of the Prospective Payment System (PPS) since October 1, 2000.  In spite of the eight years of history, there are still challenges.  Consider this question from a Beacon Institute™ member.
 
Who should be responsible for supplies for a patient in a senior assisted living facility (ALF)?  We admitted a patient for physical therapy ONLY.  Now we have found out that she has a T-tube (status post-cholecystectomy) and also needs nursing and supplies.  The facility advertises nursing supervision but it does not provide care for anything worse than a Stage I wound.  I don’t believe we should be making nursing visits in a facility and because the case is therapy-only, I don't believe we must provide the supplies.

In a few months, the Recovery Audit Contractors (RACs) will be reviewing homecare records.  One topic of interest will be physician signatures.  If the physician’s signature is not valid, any care provided based on that order was not authorized by a physician and it will be denied.

These tips will help ensure that physician signatures are valid, thereby protecting your agency’s payment.

 

• Do not accept plans of care or orders signed by anyone other than a physician of medicine, osteopathy, or podiatry.  That means no signatures by nurse practitioners or physician assistants, even if countersigned by a physician.
• Do not accept signature stamps on plans of care or orders (...)

  

One topic of debate in home health care deals with referral and admission.  When does a referred individual become a patient?  Some agencies believe that when they pick up the phone, that referral is automatically a new patient.  However, without learning something about this potential patient’s medical condition or need for care, or without checking out the home environment, there can be problems.  What if there is no physician willing to participate in the homecare plan?  What if the environment is not safe for homecare staff ?  What if the patient’s needs for care exceed what the agency is able to provide? (...)

Advice:  an opinion or recommendation offered as a guide to action, conduct.

Dr. Phil and Dear Abby are famous givers of advice on relationships.  Steve Forbes and Suzy Orman are two of the many who advise on finances.  And then, there is the cast of hundreds who provide advice on homecare regulations and compliance.

That cast, of course, includes the Beacon Institute.  For the last 10 years, the Institute has been providing guidance on compliance issues for Medicare-certified home health agencies.  In response, we get feedback from Beacon Institute members, asking why we said that or the source behind it.  In many cases, we also get questions about other people’s advice.  A director attends a seminar and hears something that doesn’t make sense.  She sends her concern to us.  Or, an intermediary answers a question and the administrator questions the validity.  

The one thing that separates the Beacon Institute from many of the other advice-givers in homecare is this:  connection to the source. (...)

The revised Prospective Payment System (PPS) has been in effect for almost 18 months and clinicians still have questions about case-mix diagnoses.  Here is one. 

When a patient has more than one diagnosis from a case-mix group, is it ideal to categorize them?  For example, gastric ulcer, hepatitis or Parkinson’s disease, and Alzheimer’s disease, dementia.  Do we get points for each or only once per group?

If categorizing means to list all diagnoses from one group in sequence, followed by another group in sequence, and so on, the answer would be “No.”  The revised PPS changes in payment in the affect the way an agency is paid; it does not change the rules for diagnosis coding and sequencing.  The diagnoses must be in the order that best reflects the seriousness of the patient’s condition and impact on the homecare plan. (...)

From the following list, identify which supplies an agency must provide and the circumstances, that being for use by the patient, staff, or both.   

a. An Unna boot for the therapy-only patient, whose wife treats his chronic stasis ulcer
b. Tube feeding supplies and formula for a post-stroke patient
c. Incontinence briefs for a patient with Alzheimer’s disease
d. Wound filler paste for treatment of a pressure ulcer on the heel
e. A hand splint for the arthritic patient
f. Antibiotic ointment to treat several cuts the patient sustained in a fall