The Beacon Guide to Medicare Service Delivery ~ 2008 Eprtion ~ OS ‘Author: Diane J. Omdahl RN, MS BeThe Beacon Guide to Medicare Service Delivery ~ 2008 EDITION ~‘his anual contin information ro be used aa guideline nthe deer and docw- ‘mematon of Medicare services. Inthe preparation ofthis manual, Bescon Health has made every ffs to Include the mos comect, cure, and clealy expressed inforacion posible. Actual corenge decisions howeve, depend onthe ete patient ‘eeumaaness, sporting Fics, repona inerpreasone and any fue changes in he ‘regulations, Informacion in cis manual serves aca supplementary gue lathe care <éelver proces and completion of any documentation forms and isnot itended ‘be wedin plac of de nerucons or agency policy. Bescon Health encourages ead, {8 t contat ther regional intermediary or sae bureas for quality compliance for ‘advice mgadingspctc cases. Beacon Health disclaims any esponsibility for pos. ‘ions ain by agence intel individual eases or for any msundestnding on the parcof the readers, “Thi manual is protected by coprighs aw, which probs reproduction withou the Permlsion ofthe copyrgheownee (©1990-2008 Beacon Resource Group, In. All ghs reserved under Intemational and Pan Amesican Copyigh¢ Conversions. Printed and published in che Unied Sates by Beacon Health Division of Beacon Resource Group, Ine. 12308 N. Corpora Paovay, Suite 100, ‘Mequoa, Wisconsin USA 53092-3380 262-243-6100 OASIS" and Ourcome nd Assesment loans Set srecademarks of ‘he Cene for Heath Policy Research Ekion 80. Jnuary 2008Table of Contents Forward ‘The Basics of Medicare Service Delivery “The Process of Sil ServiceDelivery. ‘Madicare Coverage Ceitia Palen Requirement, Service Requirement. Sleled Nursing Services. Medicare Noncoverage now Home Heal Advance Beneficiary Nocce (AHABN) Expedited Revie oonon ‘The Conditions of Participation Pike RIGhES ener ‘Coortination of Srvcer Accepeanceof Paes, Pan of Care Shlled Nursing Services Home Health Aide Services cn Comprehensive Asessinent of Patcns =. (Other Conditions oFPaccption =. ‘The Prospective Payment System (PPS) Undersanding the PPS Glossary of PPS Teams ‘ThePRS Pallosopty How the PPS Wott once Homi Health Resource Group (HHIG) Four Equation Model ‘MOL1O, Episode Timing. M0826, Therapy Need Casemix Diagnoses Health tnsurancePrgpective Pay Consolidated Billing Ourpacenr Therapy Service Supplies ron Osteoporosis Des. PPS Clinical/Bling sues Requesc for Anticipated Paymene RAP). Continuous Cae,aca psa Pyren (PER) Downcoding All About the OASIS... “TheFundamentale ‘Assesmencand Care Planning Tayment Outcomes — ‘Assesment wth OASIS “Asesmene Stele: ‘Assesment Times ‘OASIS Daca Confident, Sect and Reporting —— ‘Compliance and Care Delivery Allatour Home Vis. TRequeney and Duration ‘seed Vis PRN Visi Ranges nnn Dally Sled Nursing Vii Single Visis Physisan Orders — ‘ebal Ones Fix Transmission of Onde ysiclan Coneace Nedicaion Orde soosvemoee— Stareof Care, Recertfcaion. and Discharge SarcofCare — Recerifation Dischae on nevneem ‘Mediareasa Secondary Payee — Documentation Fetential — ‘Docimentaion Fundamenls (Content nd che Bas of Sentence Seucrare Pasig lncermediary and Surveyor Review. ‘Components of the Clinical Record. Inval Asesmeneand Hse (Cte Pa nnn VisieNowe ogres Note Nediction Profle SummaryRepor Discharge Summaryi Diagnosis Coding ‘incl Facors| Coding Faeroe Payment Factors. “The Plan of Cte oan — = Galdelnes for Compleson ofthe Plan of Car om Tcatoey-Locaror Revie of hPa xem Appendixes aa ‘Append A: HHRG Four Equation Model ‘Appendix B: Plan of Case Case Stay ‘Appendix C: Ticatwenc Codes. ‘AppendicD; Glossar of Key Teens End Not] ae References ——— InderForeword cece proehavbez ee ih hangs, ee sw ear te a oo ee OASIS danse, Ourcome base Quay Mentoring (OBQM), Ovo, sr ey (O80) th Hoe Heh Abr: Benicy Noe (HHABN) oh Seer ty tame (PS) roam fv ng har eosin Condions farses Conn halt plo eat osragec fee neces, Tomes hae IC Sey nears yc sory fr he ley of Mes =i Serafino he requrerent service dle Ede llafmennes Pa a afons and een changes 0d ave wong knowles of he regen eee af mus dle services according othe elton, The any mus Se Sr rem of ek an balance core sppropes sv he et ab se members must document appropraely, fete docuncnrion Fen a pene mee euremens he eres wee props and the asec eporded or demons popes re ate ie Mae Sr Dey eesti wl snes 7 a ec srangy, Com ec sd pe ou fre hpeof ee information. the Bsc of Medicare Service Delivery press he fandaments of Medicare Coverage resin ad the Conditions of Participation 2. The Pronpecine Payment Stem ges an over ofa concep ncn Patra Resurce Croup (HFG), conoldaed big equrement an linia sus wih iin impact, S.AIl About the OASIS discusses the sscsmens. ‘Compliance and Caze Delivery highligh sues aed sts physic ores nd are of ae receriatin, and discharge, 5, Documentation Essentials looks ax documension agnosis andthe plan ofeare, Fal, ol nd appends fearing che HRG. sample pla fcr.» SSS of eeatment Foy. youl Slr ue hrc ah ewe lone wh endorses anda nde fundamentals about the OASIS and Fundamentals clinic record, SeMedicare Service Delivery “The Process of Skilled Service Delivery ‘Medicare Coverage Criteria Medicare Noncoverage “The Conditions of ParticipationTe The Beacon Gude_—f— introduction Merge vices Your paet a ‘otic dimen os the res T: eh ae ten Sees DAM, Pa sinner yo nek 12 tae enn The Process of Sled Service Deven Homecare provides muon moe acon dele Tosca Free che bases fear deliver ant docu rmenexion, edie Coverage Cotes Tis epee ighighes ey ements in che elven of i resin he Pope Pa eT (PPS) and discs the eau mens or st pce dines et ring herpes medical neil ervies and home health aie). Se ements for coverages ound NS ‘Piticaton 100-2, Chaper 7-and fr FepentincMS Pablo 10-4 Ht 10. Melieare Noncoverage: Pcs ae te SSS ‘be noted abou noncoverage of Mea ek acai Teen cboushe importa procs “Fe Condans of arpaton: TH, ESTE apply co all pans 19 2 Pe ere cerabedomeca gency Lam impor coezps and cee Medi ean patna dele a document os Ficms Ndi Semis DANeY= The Process of Skilled Service Delivery aretha tea ip. You kno thr wil be detours along the way and radng cond net change wits ate, Your tone and resus relied. But you etme ittegou dentin on time What wilyon de? You ili rave cab Ty wll ge “yea plan maps tel ip, and al be formation ou med arog for he homecare pate a che PPS is sia ooking ip, Care deer often obs ‘perafte moment evsionand working wich ode caegiresand family members, Service de> eer ube Buble and cordnard,efienand efetv. Medicare cerficasion res eque hav he provided meet he parents indvidal needs. As homecare prov wn archer fue TReDPS. and Py for Performance (?4P) becomes realty, Medicare willook more osl at pens achievemenc of ourcomes, “To accomplish ll hse objecives re dlery us illo asysematic proces. Beas hee ats no wear ule coe the homecare pret up eo youro devlop and fallow a proces for the delivery sariled snrces, Wich an onganted proces you ca acc changes and moxify care without losing sighcof che end resals. “The proces of care delivery. also koown che musing proces, an prizes pea method of roving nvidald care ha bese on entifying and eating the pase’ niga sponse @ eral ox porn aeracons in bah The steps in he proces are Ineelaed,nerependen, and aaa Each tp sre dhe sf member in alin che requirement for servis, providing spp” pee care and recognizing the cual ements of documentation. igure 1: The Proce of Care Delivery Creme > Ani O55 epee’ ‘cds capa re, hs 4 Horsing Diagnosis itp sin er 55 fe Sepa Peale Sp ete Piero x “Tee Bae ofedicarServeeDelvry—fA__= Assessment ve Aran Ned Avocinion Sandan of lac deine ascamene "sre 7 ph he nue gh eran ih he pas gander anh verb clean ames dara cou te pase” Assesment fie ep nih PS ofare re aahihesabastobelp you mrixorandevahatthepasen’scondon, Parra perv de da subante that he pct mec the reqs for sericlnially and onan Pera And ne Meir PS, aesmene taco he Home Healh Resour Geoup {GAIRED he casei aer har eerine paen for x da pode Saf collec daa through assessment a her imporeans snes heoughowt she care dvr proces 1 The lal comprehensive asessment provides daa about he paren eds cond a reeghingeovirnmens ef. ep you pan apprope cae. Ts informe aoe spe eaablishesa baseline for fare evasion ofthe effectiveness ofa 2. Ongoing acamenc wile providing cre cles he pase’ condition andr sponse cca and can lead ro revisonsin che plan. 4. Amenmencof the pasents condition 2th ime of charg provides sigh io ‘he pn prope and rons ro cara well asthe eens of The Condos of urcpaton requ the gency co incrpors gene. and cipnespecc de rae rk OASIS daa cements o form acomprchenitessesment. Saf mas omic: sone rane gman at apes ines, inci sarc of ae, ranserco an npn ey SNP act ey eae deine or npovenent in ea carusandrecerieaonand chars See page3 «15. ey pn 0 aes odd he ates eve! of knowledge. sore, nonin physical eo el dao hsory olin, perce medial hon, body ens wah rd 4S Fn real calc ity and be condo and eminent. rea fly ac ive sis ae imiations A Colle both ebjecv and sbjecive da. Look achow well he psn mest bast regu Ca axe). awel anspor eqacmens (nda desing), cr th paces in he PPS meet Medica coverage cer. Sex pope 1e12 Evahace and iterpre dato dena drecron fr care deliver. Thin therapentic ie, eee kt ods? Le ai tan te ‘ood Cameras and prepare te fod? Ihe matted adr thet? Recordassmene da acenring agency poly. Communicate igang other members ofthe am. Nursing Diagnosis / Needs Identification ‘ac anemec dato dena pliable nursing dagors eed and problems. The uring digo Sonar cae anor comenni/rbhav ops pone mea ‘x potent alh problensor life process? By chsering the patn’ jgsandsympromsand related eo coring cern mening ar of oe, he nang gs Hens Pak fons at ace amenable co eoltion by means ofmusing actions ens thc se enable tora by mes ofwsngaetene _ “Teco Gale ne— A “There are three components to & mssng dlagnoss. The mame ofthe nursing diagnosis refers to che Jruman response. Relted factors ate suaional, physiological prychorocial spc or maturational vary dorons dc can cause or conrbute co the health problem. Document hes as FUT” (rated (2) The defining charceeristes are obsrabl ues or inferences that seas manifestations of mus Agdhagoois® “Tes signs and symprons ae eidence hace susing diagnos applic coche pasene Dcmnrthese'seridenced by these signs and sympromsarc recorded io che asessment notes is ‘noc neces to iacladedhem in the documentation ofthe nursing diagnosis. ‘Toepati bad a hip ethraplaty, One maring aga wou b impaired phy mail Uy RT pan asevidencel by deed ayo ambalte and afer ‘Usemusng digroseas the bas ofar planing, Te nssing diagnosis dives che patent lr pad coon, The gal show reson or mination ofthe problem, Threat fro ee ‘Rrrlecdonofiezvensons. Intervention should preven, reduce, conol or eliminate the Factors that ace orcas the problem. The more specif che ecology and contbuting fcc, the more ‘pein the inervetions canbe “The mara diagnosis deni the problem: pared shin rity om bts Related rors diceceinerverions: Paraplegia wit ong periods of ting in whee. “The exprcred outcome shows esolcon of problem: Demumsnate meres prevent! mit sin redo. Icervetions control or eliminate reared farors: Asx in condition. Change poston cr ery bur Massage bony prominence thre a four tesa day. Tec cigs improversirios and ydeaton For thenpy and edi sca series. ena the pases eed for servis lowing the ai on Ccprcmplyedin he use of nursing diagnoses, Sra the ned or problem in ems of fanctional limita rene denying che impact ofthe problem onde patient’ fe Ince reed medal or physica fc aw eaabish nedical necessity ofthe erventons. Kentifyan expected ourcomeroshow resolution fr improvemens, And define inervencons. New tee er stad Reledficroes: Decree ange of maton in eit related asters Expected outcome; Ptiet are fom car without astance Incervenions: Atve ROM exerci tole. Deveop and implement ume prgnas. Tesch feb to perform execs “When you compleely identi he paren eed or problem, focus documentasononche specifi prob- Jem ae well a pen response. Planning Planning lo cle eh mapping tp the proces by which aff deerme how they wll provide cre inaronpove individuals uome eed manne lnc hepsi che planing o- (a keg mind his ober specimens and sian co develop plan that encourages he fiend puttepaion. An outcome odeneed exe ln thowsthacyou belle ou can mec he patents neds the heme envionment. “Freer of Medare Service DevryAL “The proces fear planning ios foursub-seps denying pisces of car, exablshing expected ‘oneomes determining incerentions.and writing the care pan. Priorities of Care “Whenthe pasenchas mall problems eseablih priors ofcare ro dency areas of is incervention, Look dose a whar you cn accomplish within che homecare amework, given the pain’ esourcs, abies motivation andsuppore. Asign highest peorcyro he most urgent problems, hos chat chret- tthe patients sale or ablicyco remain in che home. Goals ‘Agoal orexpected outcome, decals the results you expect after the patiene recive he car. Isa pre- ‘Setion ofa change in che purines eats aa esl ofeae delivery andi drives theseleeonofincerven~ ‘sone Chane inerventons designed help che paien achieve the gal. Expected ourcmesalo serve to measure the sucess or ppropitees ofthe plan ‘Tepate cama amine The expected nto forte patie to wealindependety wit acer Teter wil ace patient aration techies and seofe wale. the time of charge the bra wl eluate cept progres tnserd aching the oak “Wricegols dha area, stainable, specific, and quantile. The gal should explain how the ps ene wl proges orrespord, nachow the nurse will incerene “Te planning procs ocwes on wo types of expected outcomes. Long-term expected ouxcomes are treo atemenes epesenting she paints maximal gin which will ake more ime accomplish. For ‘nay bomecae patens longterm goal most closely resembles a discharge plan which is wren in Locator 2, Goal Rebsbiiestion Porencel and Discharge Plans, on che plan of ea. "Pane con demon wound care techni” -Ashorecerm expected outcome i the hegre ofthe eze delivery process. Derived from the longer ‘peed outcome or patlenc aed iets the abi ofthe parent eo improve or sabe in he im- mredace fare. Shore erm gels are wally incorporated int a discipline spec eae plan. lnelade a tage dat for achievement or eview ofthe goa. Demonte asp nique ie wound ar by gst 7” you break the goals into componens or smal pases, you wll be able co demons and document male increments of progres. Fr example chs satementreflets an expected outcome which i Yexy ene and dificalero measur “Wl comply wit det” By breaking this going is componenes, you can measure progress more readily Demonte coffe exhange lis planning mea” Follow thee steps to write efeeve goal eatements > Make che paint he subject of che saree. This shows char the patents some accountability or responsi in cate planning and alo reflect the pases pacc- pion in the proces i “Theliscon Gade—fA—_ » Begin with an action verb, An action vee deseribes somthing you can se heat -Examplesinclde ambalae explain, and perform. » Incade specific content. Describe che response orbchavior yo expect te pane © cher nce of when, how wel, whee and/or how mach as appropiate. Focus fon knowledge sil presence or abrence of ymptomsor physiological ndings. » Include time lame o trp date, Thisholds you accounabe for ation orrview by aparicular dae, Fic the eimesableco che rks, Jevel of inended achevrnen, he pale abies and your sched. tn che PPS, expeced outcomes play role in dcharge and remission of a patent within the same cpliode, Verify that che pln fcze inches efecive and quantable gol wacemens. See page2+ 22. Interventions ‘Work with the paint an signcane others ro design approaches and interventions specific othe ps sees problem, ned, oc nussng diagnos, and acepabl othe patent. Approaches rust be ealisic tnd easonable othe sation. Specify who wil do wha and when, and show cooperation among the ‘regis, Include che patent in the selection ofintervention and indwidualize chem wo Bethe wique Sleaton, Comat interventions wih the medial plan of care, incorporating gency ole, procedure, nd arndards of ear. Usa blend ofasesmen, caching and hands-on procedures, nexpocae Medi ‘ore sk services, eflecting phraseology ike that wed ince now recred CMS traxmenccodes. Refer to Appendix. “RAN. nde prer ercare daly and each wife proce” “Ula by PT. threes awe? “Complete ed bath, personal care yale twice a week” Because of Outcome based Quality Improvement (OBQI) and PAP bes pracces hae become a hot ‘opie. These practices promote the delivery of consistent. high-qualcy ae, designe oimprve paint tutcomes. "The devlopmenc of bes practices i specific wo an agency. Seepage 118. The paces ‘muse within che ageneys policies and procedures and mex the needs of espns physicians, and sll Care Plan ‘A dcipinespecfccae plan diets thepecficlncervenions and cilatescommenicaon wih other team members. eserves as the wren map to guile cae delery and documensatoa and ficiace ‘coordination of services. Discipline specific cae plans ae not mandacory so many agencies donor ase ‘them. However as 2genclesmoveinto outcome management, OBQl, and PP.che value ofa wee cae plan (ors derivates, such sical paths) wll ecdme more obrions. cae plan ides tha aff rested all patene neat evi the plan ro reflec changes in he patient station ad caved ouall tasks and char the paleneparpared in che proces. Se page 12 Aeeratives eae plans incde are maps aching plans provocls, and dieae mangement ool co ame fo. The ae ln these care planning rool comes fom sandardiaion, The ollys ura ph for care elvery forapatientina given stuaton wth pacer needs. Following cis path minimizes possibiicy for crore and omissions and promotes consixen ct pase forerorsand omisons and promonessonssenrsve “Thea of Medice Service Deny 1—A_ Best Practices Questions and Answers whatisabestpactct Jn singlets best praise proceso proce it ose " Uppercut ety av dered cones u Wotcoetwadd Set rie bud eth ca acts asim ching rae Dein abet pctce res, corination,.— that py nave sation Kou include semen fortomecare ane of ates, rt jus assessmen nd foes on care deliv actos, ot provides! Jntdecunenton,[Dacamantatio shel fw fom he ae ove) The {eee pacte stem shuld prove he inkrmation othe lian knows tracy what io dy we, how What isthe pepo of By dering specifica actions fr apart ston 2 best pce, Thetpeciat™™" — Blandudlsr ie peach ioc dlnay, her tredce son and subject neni ad ang pans. Simply pt vaio les © the tere way raf provide et. tamper One nse teaches peers ith heer are hawt en wih att tlance ante tach abou ape Ton neh nny ce cpr ts exten an The second nae fcses en en ea rae ‘Only when sone nowt watts cae ofr paw ncn ‘cutancascan gue out cons improve outcomes. ata some ene yen doce dling cinco nen on stemtpecness 8" Aches espe nssaren cv orca a utr re oe erp oe ono aftr tang pln, o meando pote seo ‘What rehicome ith Th fat one obvious — inproved outcomes of ae Tats te renzo bes beet pnts rcs ar geting athe tein ow Iplerentng bet practices alo gies you the geste oppoctiny fr sate. {fe operational and nancial adhantage. To compete eleiel and achieve ‘sie outeames ate PP, homecare provides mus be able rei wil tionof rence and resources and the col sevice dev achieve the ‘desved elt. Through he sandaeaton of incl sound son wich ave ben shown to work forthe agency patents agencies wil now what thet lnilane do, Bet practices can alo pay an portant ol in developing corecompetencis, ‘note hot open ome bean eare Coe competes este buns ‘ipa tht proves company witha matkeploce advantage They ae the {kiss knowledge, ad characteris tat ep det uperio pe fomaace and are the om eset of a company’s ofan nial parse ‘Com competencies shold take ino consideration he agency's bet pacts. Where dow begin would be nice and easy you could go out and buy a compe set of bast wth inplemeating best I pracces. However thre’ no guaran those would werk in your ager. prctcer ‘The bt paces have 1 wih your agency care delvey mebod pls, procedures, pyscan pacts, Tobe succes, best practices shuld ow out of the agency’ ally improve- Iron proc The et ps erening what cna cos py ee gen ‘Tonto Ten, on agency te Sn dein wha nian ‘aright or wrong, good or ad when, owe. Ths icles hig your cine cen deli sengh and pole steve. Fos, [Faure outhe covelaton betes ben psc nd ocr vo The Bean Galde—A—_ Implementation ‘Once you hae denied the patients needs and developed a plan imlemenrain puts the plan taco feton. ei the oganitation and atl delivery of care, crucial o achieving outcomes. Dusing care ‘elves seas che paiee and derermine prions of care Coordinate services, communica cae wich ther member ofthe team, the physician, che patent, and fal oF caregivers, and illo exabished policy and procedure. Supervise staff according so exablished promocal, Evaluation “The Ametican Nurse! Asocation defines evauaion as the proces of dxerining both the patenés progres toward he arainmen of gels andcheeffetvenesof the mang care” Throughout ee deliv- oyna coleeand ecord daa once patients condition and respons, and modify the plana needed Iehis fal xp, compare ehe patient health condvon and level of fancining tothe dened ex- pected oucomes ‘Evaluate two eric components, Look fre ae changes inthe patenc and how thse changes lft ongoing care: Caliece data ro asses che pend sponse, performance, or progres, compasng then touhceapeced outcome ct. Ldn ay changesin condion or nesds. How asthe pasen pro. {posed toward atheving th goals? Whacimprovementsorchangein behavior do younosie?Resoed ‘sponse prey. eoncily, and objectvaly. “Complian wit melcation regimen. Edema rtoed” ‘Docume even the smallest changes or Increment of progres, and compare hem ro the baci, ‘Theor gal wa fr th patient ambuatendependenty At the time of eauation the patie ean trae bt nt ambulatendependety In documenting ce evaluation of patient progres stead of emphasting the peeved ilar, nce the pve guns in comparaivelangags. “On admision patient cold not tmbulateosand. Can now ten independent” “Then look a the appropriates ofthe plan. Erslaion determines whether che needs ornursing dingy roses were corect whether the outcomes were esonable and eas, whether he inervenions were Sppropriace andthe impact of hero plan on che patient. oo Tit “Thetases of Maca Servce Davey—A_ Medicare Coverage Criteria transla the egulstonsino guidelines for the delivery ofhome eathervicescovere by Medi fare The implementation ofthe PPS in 2000 and subsequnc revisions ir 2008 did aotchange the coverage criteria. I only modified the pymencscracture, Seepage? +9. You mst be familiar wch and. ppl the exes they appear in chis publication. “The requitemeaes for coverage of home helh services fill inco three broad cago, 1. Balen segiremen: » The patient murebe homebound 1» The paint cannot reside in an insicon chat ments Medcarés dfition of hope or nursing home 2. Service requirement: » Services re provided underaplysicla’s plan ofexe. » Services must be reoable and necessary. » Services muse met the qui cteca for home health cae nd the coverage cicero pacme or inermicent services. 3, Discipline requirement: » Medica coves services— sled nursing, physical heap, ocupaional cher- apy apeetvlanguage pichology services, medical soci services and home heakh side services, > Bach service must meec he specified exer “This chapter highlighe selected porions ofthe regulations, noting the ection in che CMS Publication ocrefeence.Becase theres cannot cove ever uation, his chapels presents principles to gue ‘care delivery sn documentation decision’, i Medicare Benefi Policy Manual, CMS Publication 100-2, Caper, Home Health Services Patient Requirements The Patient Must be Homebound Fasc andere he patent mse be cone hi or herhome. The Omndous3udgeReconciaion Act ‘F197 revel che definionoFhormboand, which sincorporaedin CMS Publeation 100-2, Chapcer7. 30.1.1; Anindvidal does not have tobe bedridden to be considered as corfned eo hi home, How~ ‘er the condition of thee parienes mc be sgh tha there elt a aonnal nab co eave home and, conser avingec homes would require a considerable and eaxingeffor. Generally speaking, a patient wil be considered robe homebound he/she has a condion due oan illness o injury which resuics his/her bir ole she place of residence excep with the ald of apport devices such 2 erutches, canes, vheelckas, and walkers. the use of special cansportcion, or the assiance of anoher person or fearing home is medically contraindicated. Te “The Beacon Gide—A. “The Benes lingrovemenc and Protecion Act (BIPA) of 20 revised the defnion to address day-cate programs and elgious services. 30.1.1: Anyabsence ofan individual fom thehome areibuable ro the eed ro eceive heh care treat- ment inchiding egular absences for the purpose of participating ncherapentic psychoso- ‘al or medical reatmencin an adal day-care program thar slcesed or ceri by 2 Saxe ‘or acceded, ro Furth adule day-care services in che Sate shall oe disqualify an individual fom being considered robe confined ro the home. Any other absence of anindividaal from thehomeshall nes dequlify an ndividul ifthe absences ofinfequent or reaively short duration. For purposes of the preceding encence, any absence for the purpose of attending a religious service shouldbe deemed robe an absence ofinfequent or shore dustin. “These paragraphs ince several hey concepts thar we ean trans into thee questions to guide cre delery nd documentation. 1s the patient confined to home? “is, dercine hat the patient is ined confined come. pains can lavehome regula = will for whatever reason they desi, evenifit takes get fort they wil ncbe considered homebound. The patient bad everest arthritis and cold not preparer meals, Wt thai ancora ends, he went ut very day for bch, She was ot cmideed homebound be Cite demonstrate tity ta enhomereguley, gerd of th dif ioe or asitanc required ‘Absent oc impaired spech by lf docs nousifyahomebound dexrincion® «ls the confinement related to a medical or physical condition? If cepa is confined co home, that confinement must lated vo a medial or physical condon. A patient with no physical or medical imitations, who dcidesto stay home in orderco qualify for Medicare average may not be considered homebound. Funeonal imitans indy the impact of che paces ‘condition on his other daly fe and help support homebound decerination. Seepage | «42. ‘What about absences from hore? ‘Once youve deremind that your pten indeed confined ro home, crate any absences, Absences fll into ewo categorie: thos for mca or nonmedial reasons and chose forthe purpose of reciving medial are or treatment Forsocal reasons the absences muscbe frequen or ofshordurcion.lafequenigenely viewed as lesthan once week? There ino offical definison fr shore duration although the CMS bas ovr the years proposed a ine fame of woo che hows [feb paint leaves meen one a month ogo ot beat sop ths wold be an exanple (fan neuen asec [be ptins cannot be lf aloe and mut acompany the caregiver to pick wp cin at choo his absence would bef tort darton Eventhough che crcera tate chat absences mast be infequenr or ofshor duration, appears that che ‘hea of Medicare Sve DaveyW Hi Wi —A__ incerprettion sling coward infequent and shore duration. “The patient may leave ome to receive medical exzment — as ofen and for as longa necessary co re- ceive thetrermen, Examples ofabsence sribuable co the need co receive medal care nude ongo- Ing receipc of oupaiec kidney dialysis, chemotherapy. and radiation therapy “There are some medical absences that requ explanation. Ourptienecherapy, consolidated ino an agency episode payment, conse serves that canoe be provided inthe home. Lenin home ro recrve ches services doesnot jopandize homebound sats. Theabsencs,howeve, should require as- sicance of mother peion ota asisve device and/or invele taxing efor. Caria chabilration at service tha cannotbe provided in the home. There nus be appropiate lec ‘wocardogrphic monitoring deflator and lfe-saving equipment and rained peso performing: the program under the supervision ofa physician, Once a patient ens a pro- gra lel benecesary copay arension ‘to whats happening. es possible thar he or he wort be homebosnd for mich longer What icthpatient ding th pro- gram? Hos quel dos th patient eto the el of en able» wares dances ito autre or tasing ort? rio co leglave changes in 2000, a- tendance at adule day-care aogeams, no ‘mace the reson, could cos patients thele Medicare homecare cligbiliy be- cause they were aoe homebound. Now, arcendance a2 eatelicened ot cert fed or an accredited daycare center €0 paricipae in media. pychosocal, oF thence eeatmene will noe negate 3 pasents homebound sans. This new provision docs nor define cerpeic oF psychouocll wearment. The CMS be- Teves chat pases, jus by vitae of a ‘ending 2 qualiedcener, recive some sorcof therapeutic or psychosocial eat “This provision is not without ics chal- lenges for you. Pus, ahoecare agency oust very and maintain evidence that ‘he cee i cesed or czred by che Sea and/or acreied bya accrediting rogram. The CMS blives tha uppordng documentation could inde the number andefcceve date oflicensur or crication andor the acreditacon number, and the name ofthe author’ responsible ew = Theteacon Gade—A_ forlcnsuceoF etcaton and/or scceiaion" Paes who atend a daycare program thi docs socmet the qusemen, no marr thereon fr atenanc, wil not be considered homebound. A homecare agency can provide homecare ervicsto patent whe they ae ache daycare cee. Document she reason and type of treatment ha the patent recie athe daycare cent. Not ony does hs help supprecomplnce wth he homebound queneny, i demonseates coordination of services. Scr der of documenting reason for atendance ats dsyte progam rated ofl Or carer issues eg he dagher mocks. Anendance mus lero che pacts prtipton in ea tment. The cna ear should demons hat asporing the pte othe cee ques ai- tance of another prion orasisive device and/or requis ing or Another homebound concen isthe patent whodeiet. The Cntr for Medica and Medeid Cones (CMS) has sd eat he fc pases drive sould nor raat dali shem om Medicare ov- nage! Lookatall he fc. The question of medal cen fhomeare servis comes i ply. I ‘hepatic dives cane oshe dive acini aroupaen department rece heh careers? In any ees this would be te andthe pace woulst nel homer services Homecare nica convencae thos whoa eve home However the pase nes in avery ral sea and he ea steal eae ees ae 5 mle aay. devng ht igh oc bean option. ‘When evaluating your patents homebound es, ou muse it decd hat the patie cxecaly confined home ard then determine whether or not ene fo he home ect ci hepatic igual and eure maxima asian wit personal crc andi en ei a ariel whe Onc the pati the whe boocer bec get “rund wil atendng sa or ork. Ts patent wad ot Be cme bomehnd Ieee ett nine oboe, Th pate haz ALS and rvntlaterdpendent. He eave homeo fr mei pint ments. Tiptree confide ame nd weld be conde bombo. he patients fo adeneed COPD andi cantina agen. Hoc, with he ttn fe fay cede and poreableccen son seks boner day 2 ly ings Siew ot become boncownd Other Homebound Considerations (CMS Pablision 100-2, Chaper7, addres the homebound xara of paren wich poychiasc prob- lem. Te patene with a"pschits problem, fhe linear manesred in parc by refusal co eve his het home envionment ors of such a maar that woald not be considred sf fr him or he to leme home unatended even fhe o shehas no physical limiionsiconsidted homebound.” Know what the regulations sy and focus documentation onthe paces ley, hepsi as Alcbeier dase and becomes very agitated. Te patient walls about the ame mo ofthe day. Foner pain cat go down eps witout astane,ierpret ‘raf sigaals, or eres theses say This past ms fe ving the be aloe, 2 ‘ug there arene physical intone “Thehome envionment may fet the psen’s homebound determination. Factocssuc atic ghee ofsteps hilly tran. and seep inclines ca ine the performance of patient and spore homebound decemintion. Describe the Fanesonalliitacions (what the paint can or eanot do) along with the “The Bas ofMalicareSevies Daveyaie celted physical or medical condition. “Canal only one fight of tp fire ecg echanted and dpi Livin third flor walk apertment” “Ga ambulate150 fer with walker then experiences fig. Eletur i 20 ftom apart ment. Cant canbe on tia” Environmenal condition mighe alo restric the pasen to home. Diss withthe physican the nex- tclaconship beoween che patient’ condition andthe environmental factors and docamene tae dcus- lon. Beste thee paints willbe homehound for very shore and rpecicpsiodsofcime, documents- ‘on is ruta to suppore your lim, “Hemi. Unsteady st with quad cane, uefa ambulation srw andi” “Respintory condition severely aggravated by acane daring pros of igh et bid. Pan vdere patient stay indoors uy “Therarecimes when apaine maybe considered remporariyhomeboind. Thiscan occur afer surgery foc when 2 chuonic condition hasbeen exscerbared by an lness. Wea providing care, emphasize the inflence of dhe exacerbating condition as the rexon for che homebotnd derermacon, and not the chroniediewe ‘The patient wth ere weak fllosng major surgery canbe temporary homebound. Seth will return a the patie’ reapers. Paes the ate limitations when doce menting amend at “Experiencing ain and wees aftr ngey. Abate only ‘Sfet wth ais of ore” Avather examples the COPD patent reccering from prmanis.The patient lied with (COPD befor but hile ha weakened hi. Faas he exertion of tendon «aed ts ipac. “Experiencing created SOB duo puma. Atty decreed tra fos from bed chat with aie” The Ftentin an Asse ving Fy More and mor homecare provider fd hechesconfonred wih de isu of peoviing ae op sientewholives in anased ling lity (ALF) rather eype of oppor housgsangement, sch asboardand care home ora reremen fly. There se three quests you must sve Fig ithe ity considered an inciton oc a rerdene? CMS Pablicon 10-2, Chapeer, ayes reidncels wherever a patent makeshisorkerhome alongs demi meth dean ofan ‘aon Seepage a. Ite ile enploys muses provide sled neingae ema be considered an nsicuon and che par wuld nc be eligbl fr home heal eoweage Second the pain cligble for homecare eves? The major hurdle be descmining whether ot nocth pane homebound. Theres nocay way 0 dene bomcbounl afr ailing nan [ALE Rerogate thse aretighenng the cei andinerpeons or homebound at “The elooking orca the pact oval moby and acca pen ve he icy fogroupmiprand civics, chy won be considered homebound I pans go he dining ea snd chen pend th dain acaises they may nore homebound. pares eu aiance oe the dining sea snd rumor rooms serch mel ou cold ball ce fc homebound et rie — TheBexon Guide—f_ _Afirevaltacing homebound sacs, vey char che pine needs inten sled nursing, physic _cherapy speech hnguage pathology svies,o contiauing occupational therapy. and would ecsese> ‘ices under a lan of eae signed by che physician. IF he paten i cig for homecare srvies, the agen san provide sll cevies “The ls hse dae with providing home heh ae sevice co pacencsin ALF. A homes agetey ‘cannot dupliae dhe services that a fcliy does —oris supposed vo — provide. You must deide: Does the pavenc ave acest appropriate care? Desrmine whether the cys lcensed bythe see. Iie Is check che regubtions to Sdn the eve of perional care and supportive services che ly mast provide. Ifthe cia iano licensed, check the pacents contract derermine what services he iy Isobligaed ro pevide. Ifthe fcc is bligaed to provide services, che pasne cherefore has access ‘chem and ewouldnorbe reasonable and necesary for an agency ro provide the care “The goverment and intermediaries have provided very lle subsansive guidance. Is imperiethat, you study he regulasons evalua each patient’ sacon, and build your case hrough docunetstion, ‘The Patient’s Place of Residence “A residence is wharevera patizne calls home. This may be his o her own dling, an apartment sclacives home, a home for the aged, or some oer rpe of insteution. However the paint wll noe -qualfy forhomecare coverage ihe orshe resides inaninsutlon which meets Medicare deintion of hospialor nusighomeas defined in Sections 1816(c)() nd 18193) of he Soll Secu Act. A tnsieuton may not be considered a psient esidence fe 1. Meee alesse base requiem in che definion ofa hosel. ei play - ‘segedin providingto pases by or unde the supervision of physictans diagnose and thezpeu seve, orchabileaion services 2 Mecsarkastehe basic equrementin the deflion ofan SNF (sled nursing ity Ieispimarlly engaged in providing ro inparints sled nusingeue andar sevice for patents wo reqhite medial or nursing creo ehablltaon servi All nursing homes ths parccipate in Medicare and/or Media as SNF, mose cies that parcpate in Medicaid a incrmediace ere ales, and ome nursing Ihomes which do noe partipatein Medicare or Medicaid met chi est. Even fhe paseneissckenough tha services would be covered in an nseuion, he or she sensed homecare benef. Kyouhsve sy doube abou the paren’ pace ofesdence, conade your termed, ‘Medicare regulations do noe pelibicthe pan from having more than one eesience, eg, homeln the dey and aconage onthe lake. Nor dos having moc chan ane daguay pine on the base of homebound satus Is kmportan to invetgztc the patents homehound sata ech location. The pine must mee the requirements of homebound sar 3 each locaton. How does the paint get there? What does heor the do once che second residence? One sched ery oonth daring the omc the pati gos with isi w ret 190 ilo bic apartment. He rider with bis emily and onc terri grand here tehel him tthe ler eid the cabin where be watchs them fb. This pate could 2e considered homehound. “Thetis of Medicare Saves Davey Teii= = Focus on Documentation of Homebound Status Documentation ofhomebound sts consis offour esental componcats!? 4 The functional limitacion() chat esuics the pvients mobil. Tis isan cbjeclve buebrosd description ofthe paiené’ imieation, which comelate:tofaneconal in ‘ations ised in Locator 18 on che plan of care 2 The medical or physical reason(s) forthe limitation). The patene must be home- bound beaut ofthe ects ofan les or tury 5. Impacc of the limitations) onthe panes activity. This deals the specifics of che paten’ station. Include the use of aslive devices othe help of another peso and detail any eonsdenble orang efor” 4. Absenes fom home (nurber andeason). The sppore the Far chac the patents ‘eonfned eo home. Docamencal four componensin che intial sessment and che progres nots and/or sum epors. ‘Selected OASIS dara clements deny che pavens Fancronlliniacion. Add nataive comments fo ‘ound ou the four components. Here are ome examples. ‘The assent reves that the paint ha severe shores of breath won exertion det (COPD. Thema ada, "Canna ambulte ore than four steps before rating. Leaves bomse Jor MD appuiniment nee amonth™ ‘The asezment sh that thepatinsunabletoambulae andi confineto aber de ‘aA. Therap write, “Doesnt bac thetregth to pusher more tse shart detances. Vist danger for diver ncea month” Follow chese ocumeneaton guideline to support che homebound decermintion: » Complere OASIS data clemencs accurately, especially those tha can suppor home= bound seats such as ambulaon, wanscrng, nd dyspnea. » Comeate Locator 18 on the pln of care oeflec the patents Rncionl iniaions and acves, » Reporeon che plan fare a diagnosis chac explains the reasons fc the niaion, » Recordin evry vist noc a brief ave assesment that mppore the homebound: determination » Aske every vs shout the paren sbuences and documene pecan findings. Foe lov upon any quesonable paces. » Document the sistance char he patient requis when kaviaghowe and any elated taxing ffi. » Mainain consistency in your desripsons ofthe patents cei. ‘When evaluating the patient's homebound status the intermediary will eview 4. The plan of care, Locators 18A and B, functional limitations and actives permite. 2 Thecompehensiveasesmen, especially OASIS dia demensonactivies of dally, living (ADL) and insrumeneal acces of dally ving (ADL). 7 Be Geht 13. Documentaon in che vie aces and lw sheets deserbing he pasient evel of mo- bil and ct Service Requirements impact of Other Caregivers on Homecare Services (CMS Pblcaion 1002, Chapter 7 speaks the aval ofeaegives in che ome. 6202: Wher the Metcare ciao coreg ofome he srviesaremet paces ae nied by Ineo coverage of enable and necesary home heath eves. Therefore. pate ened tohave the coo sonable snd neces serves reused by Medicare wihoat regard torwhether theres someone salibleinchehome wo frnish them. Hower, where a fly ‘Romer or ode peson sor wil be providing services ha adequately mec the parent’ eed Troi oe be resonable and neces foragency personnal ofr sch services Oxia iyecan be presumed that heres no able and wing person o provide che serves bing teodred byte sen anesthe poo fa indicates hers nd ajc othe pron Sion ofserleby the gnc. or cheagecy has Bichand knowledge othe cone. Ithaca ary membes or other penal zeges living wth he patent, does the read describe the stato? deni the ndidland docamen thos a chen asesmene “Liv wih dager hedging end bouckepng ba sulin por perma are acter ait” Provided Under a Physician's Plan of Care $30.21: Theplanofearemustcontainallpexinent diagnoses incudig the pent mental sas he ‘ypesofsrvicesspplisand einen ordre, the quency ofits obe ade pogo ‘Zhabliacion pore functional miacons, aces permite una requrenens {ll medicaons and eaten, sefey measur to prove ais ini, and ny aon ices che agency or physician choose o include. “The ondins of Participation also manda the plan of cro ince tes sume components. Set 28°65. When youcomplte the plan ofcare you demonstrate compliance wid the cericaton cover Span payment requiemenrs forthe medi plan of axe. $30.24: Theplan fare mustbesignedand dated by aphysician..befor the aim foreach epsode Issubmicted forthe nal perentage payment $90.26: Theplan of care must be reviewed snd sgnedy she physician who exablshed the plan in consuleation with agency profesional personnel atleast very 60 ys. $30.3: A paeneis expected to he under the cae of physictan who sigs the pln of car and py Clan ceaton. les expected but oe rege fr coverage tha the phys who signs the fan of ea wile the pace bur re sno specie ner of ime win which che patent rnuitbe sen. “The Condon of Pacipaton, $6 18), sete thar che atending physician and ageny ef must reve che plan of eaeas fen asthe svt ofthe paent’coniton eqs bata one every ‘Tig of Medicare Sevee Dery Bfi days. May sare censue codes have their wn timelines reqiremens fo he physician signature Moticazecn conser he pln ofearem be terinatifthe pent doco a kescone covered Mieatcangorqlijng hemp within a day prod. thee arn vss in ch ped and eared eer ce lant incadea saeent wich doce thatthe itera wot cae ‘prorat dhe denen f the pen? lines rin. “pain ies dled marin vit cry day for sane ctetechanges Lactor D1 ibe pn ae ince, Reires SN it ery 9 da fr ct charge ad o- Prope menage Reasonable and Necessary Services §20.1.2: Medicare doesnot deny coverage solely onthe basis ofthe reviewers geen inferences bout asin wich similar diagnoses oc on data elated ro uization general bur bases it upon [bjecive clinical evidence egading the patient’ individual need for ee. Tobe considered reasonable and necessary forthe dagnoss or eatment ofthe pent lines cijury the eves ust be consistent withthe nature and sever of he illness or njy, ‘he patents partiular medical neds, and acceped standards of medical and nung pra tice, A patiencs overall medial condition i valid aco in deciding whether sled services Atenecded, A patents dlagnosis shold never be che sole acorn decdig chac a sevice the rene nec ile sled or not elld. The dererminaion of wheter the services at re eee and necessary shouldbe made in consideration that physician has determined char ‘he sevice ordered are easnable and necesary (CMS Pabliction 100-2, Chaper7, emphasizes the physcianscerccton athe bass of reasonable and sevesay sere. Each service has own cites bu general the eves mus be consistent with {he nanne and severe of the psn ines iy, and aceepeed sands of medical and nrsing ‘rete. Lok atthe patient overall condicon, no jus the diagnos in conlation with the quency I durton of services oeered. However, dor overlook the importance ofthe principal diagnosis in Sapportng the plan ofcae. Refer to specifi disciplines, pages 1 25-1 +46. 0. Part-time or Intermittent Care Probably oe of che most confusing sue for homecare providers to understand isthe parc-ime oo ‘nieen Cae reqalrements. To beter understand thissur, look arin ewo pares: «+ ch qualifying xeria for bomehelch cate serves. and + che coverage clea for partie or inrermicen ae. Qualifying Criteria “The pacencm pass the qualifing es fit. Ter One of the Desk Ad hate the qualiffing xtra ‘Tobe cighe forcoverge, « Mediare pane mus demonstae tat he or ah is homebourd and is Inneed of lle ausng the isreasonable and necessary. and isneeded on an inermitent basi» OF plysal cheap... speech-language pathology services... ora continuing need for occupational sher- Pr Any onc ofthese services qualify the patent for coverage. (The need for occupaonal chery Ail oc qualify che paren for Medicare overage. The patients cll for occpaionlheapy must ee ee = TheBeacon Gude— DESK AID — For Use IN DETERMINING IF SKILLED NURSING AND/oR AIDE SERVICES ARE PART-TIME OR INTERMITTENT TiéR 1 — On what basis i the patient eligible for home health series? Does the pale need ysl therapy, speech ngusgspathobosy services, oF continuing occupational therapy? YES NO ‘Dou the patent eed sled murng care ‘fewer than 7a HETthan hows en dy for pt 2 Sys, th ‘Steins tn exeptlonsl reumatances wh ‘ned for bdo eres ite and predleae? Stata raring | [ The patent rat ecaincrnant | | tpbitor tune xranents aah serv I Tre ds wis present? ves] [NO Gore | [ Reviews ior? | | complete eo ae Spare Ran Ow mao aa a op Te Ele err ons cp ne ncn nv ene De AM ihe among Taste uso ras, seer creeera eon notre donee ad pen cenmaance spring ic ep epee nd Irie ange eRe “Tie esc of Medicare Service Dre Tea— DESK AID — For Use IN DETERMINING IF SKILLED NURSING AND/OR AIDE SERVICES ARE PART-TIME OR INTERMITTENT TER 2— fe combined led mang ad bre ah ie at parttime or intermittent |s the patient recelving care les than 8 hours a day? 7 5) wae plat cag atte eat | aaa] oes No L ves | Festa | [epemtenreanna as tiie fen ee ore f ia [No sspemres ah Eo J netics |) ee, eccnetatete [| eee YES] ‘he definition of pa time o terme. carels met for hore The deiaion of pa ‘ne or corel met for 35 hous Si aa a pe TheDescor GadeA be esabledby vee of prior ned forse aright hep or speech angus ploy serves inchecuren or pr cfc ped Onceesabised eee for oration herapy Can qualify th pain for ongoing serves) “The Belenced Badger Ac F197 seve he defn for ineritent nasi kissed musing cate cha: + ther provided or nected on ewer than even days each week: of «provided ess than ihc hues each ay fo period of 21 day ores wth xenon Incncpind ccamsancr when the need For ada ae is finite and pedi able Failed musing she qualiffng service, Medicare does por eover sing ursig vic ithaca you planned delve Examples would be rangle vis fora evan ort administer an nection, The Balanced Budge Acta exempecdvenpunctre ara qualifying service. Thar means he pct whose only nced for led ae evenipancrre would oc qualify for Meda coves, ‘Daly vss ste vs provided seven dq ack. (The previous definiion defined daly 2 feo seven Jasaweck) Toavoid denials of aymene, en eaisticand acheable date when aly iss wilend ‘The patnt asa ope, desing pres wer, The py and marcel ed for a for cmon ret hele 1 she ntaion of daly vies che agency ad pysclan do noc idey aint pod so apps tha day masing visti contend he serves Jo not mec einer: dein of nursing snd wlloebecovered by Media ‘Te patet eee daly led mn ts for an nee proof tif arin to of mal perentral mariion (TPN). Besa thee fine period nied te serra at ere by Meare ‘When the pains ecting physical eapy or spech-dnguage pathology eves or has contin {ng ned for ocapaoal py, dy sled musing ists an be povided unde the coveage ce {tt Thes eter do oe equa Bite period fore. However, when he quaifng therapy service ‘Siconines nd led nas is he ony sled service, he docameneaion muse ceay show cat theres pede nite period fr daly vis, Wie ppers that the sts wl cone indy che portent docs nor meet Medcre crera,Remeer che emt cite aplonly sled a. Ingservies. A dheap, mcd scl worker, orhomehelh ide may ke singletons nd ecesry when the pent qualifies for Medic covenge Likewise when the pan ilies for coverage through ane for therapy. Medicare can cove ssngle phnned using vis eg for veipuncare The coverage erie donot describe a recuing eed foe aring sits Will sing vise by che physical heap ree anguagepahologi« qualia pen fx ongoing caput thy? Somelnermedaries have aken the sad hari does no qualche pate for coverage Bat bythe ress posible — hey noe subject the nemicencrequen. neal. Iowever: its doubl haa single veel nabs anced or che service. See paged 12. “Tic Dases of Medicare Service Davey 21 haere eases and document periodically the patents ongoing limircons and need fr nursing servies, and ‘he unavadably of eargier co perform the injections, ‘What happens to patents who can elf infect bucannorpefilindin sings? Medicare does not conser ‘he preling ofyinges tobe sled service nd anced expelling wil oe qualify the pan for coner- ge The CMS vl ths at ating che pasen with elFadminieaion of mediation dur win the ‘oeofthehorehedh ade, However, where statlaw equi thaa nurse pelsringe andthe patient ‘plies for Medicare cover," dled nrg visto pel ering pad riled aursing vise Subcutaneous injections {0.1.24 Inevenous lneramuscular, or subcutaneous injections equi the sil of Hiensed sree tobe performed (or eught safely and effectively, Crain injecable medications are considered obeelinjected: hus they would noe orinaly require ‘heh of nurse or physician for adminseracon. Becaue of coverage decons chat afec oherheakh care provider intermediaries ze challenging sng vss to administer subcutaneous nections. Hom ‘er there hav bees nochange in he bac guelinescoveringhome health cae Injevions require the dlls fans. To build case for coverage of subcutaneous medications flow these recommendations » Verify tha the mediation is ecognaed s easonable and necesay teatment forthe pints condition » Report chat diagnosis on the plan ofa. » Obeain appropriate and complete oder forthe medication and nursing sks, » Document why he paiene cannot selFinjece and that here ino able, wiling, aval able caregiverea do hie Unskilled Procedures ‘There are many procedures that Medicare considers tobe unkiled-noczequcing thesis ofanarefor se and effcive performance. Thos induce adminiseation of oral medications ey drops, and opial sinuens,peiling syringes, single wound exe and routine ostomy cae. These ae not sill no ma terthe cheumstanees, Including no caregiver avalable odo ‘leo on chili routine Foor care, even for diabetic paca. Medicare doesnot cover cuing ft: nova ofcoms or calluses; eimming, curing, clipping ot debriding of als and hygienic and preventive ‘maintenance care such s cleaning and soaking the ee and application of skin eresms co maintain sia ‘one of ether ambulatory or beds paens. However, thee are excepions ro this policy. A medial condition exe thar plces dhe patent i «ceased ik of infection and/or inary fa nonpeofsional provides these services. Medicare would chen _mcognie foc crea equirng the sls ofa nurse, therchy qualifng che patent for coverage. The ‘ccepdons ar lited in CMS Publiestin 1002, Chapter 15, $290.2, and include: » A diagnos of metabolic, neurologic. or peripheral vascal disease dat may eel sever cirelatory embarasment or areas of diminished sensation in ce individuals legror ice wea— » Evidence of sgifcane crealatory of trope changes, such as amputation, absent pulses, clauhcaton, nd edema Beeuse of sjstemic condition, suchas diabetes. and sigufcane cline indngs ican cake che ll of aseto perform foo ear saflyandeffecively. Focus on Documentation of Skilled Procedures Documentation must prove tha he procedure requires he sll ofa ure, Starweh pertnenhisory and ignicancasesment findings, acluding description ofthe patients and/or cxeives acon. ‘On the plan of care, densa diagnosis to cocreate with the procedate and lis eompler ders of the procedure eo show che sil evel ‘Visi nore documenraion ries a question. Must the nurse document the procedual dra in every ote ois i aceepeabe to write "procedure done per plan ofcae’? Ben fie ake few words, writing ‘urthe procedure maybe che sfercanswer Inco many eats, surveyors nd ou he ure has oc been doing the procedure per he plan ofcaeand che gency fics survey ckasons fan gency hasa poine ‘oFcaredocumenation the procedure would ben these, Another option fs toconsierdheuseofa flow sheer, which notes the decals once andthe ignarares ofr over apriod ome such asa week. “Thee ae some ists with flow sheets, such a eping them updated sd geing them eure co the pint incl record ‘Also noe the paints response, which includes how te patent clea che procedure and any change instars, Reportco the ply and docimenc ny significa nding nd changes in the plan Teaching and Training Activities {40.1.2.3: Teaching and ning cvs, which require sled masng peso each pane che pans ayo aegis how to manage the treatment regen would conse Stiled uring eves Thee of wheher a muing services lle lates oh sil euired to tech and noc the arr of whats bing gh» Kile ning iF techingand walang cies are exonableand acer wher teaching of lng, isappcopriatro the patent funcional lessor isles onary [Note These mo cequiement thatthe pct fil, or the carer be taught provides serve hey cannot or choose nox provide the cae “he hd sled servi, echng ad ering ace probly the nse dtd end ese documented ofthe sled nursing servic. Nace do noc aves recog he cone and impac ofthe ‘echo they do, Teaching tc homecare patient fen done nan infos onvestonl snd some tires enctversanoee pantech te dhe patet abe nln ands rcs. Howe, teh the pation mya dr bear, fet eet Yo tex bin abot are ed ron of fo and otc the pe, laying te in distin ‘racine i (Chances are you do no dcumen this spur the momen eechng, Beau ews notin your plan. ‘sare aly ingen led serves delivery isi Gom yourno. “Tein of Medicare Service Dery Teal=f nhe meseayvew mach ofthe eachlag common-sense suggestions, oc worthy ofocueain. Toke the example of the patien wh recy decoped lowe leg edema. One of you fit. _ gets wn befor tpt vee bis les when ting. However thsismorethan common-sense sugeson, isan example ofeaching based onthe nus Meteo Knowlcge and expsence. Yue aught him an impor fn mans fit Tire Tak edie frei caching by documeneing “Thee are emo important pons remember about each > Ifthe sls of nurse ar required teach he pacencor caregivers how so mane the lacaunen regimen, hen aching considered medially resonable and neces 1 The sil isin the teaching: nor in che subjeceaughe. ‘he paint bad ame exireniy amputation ad cea parse 1 wal be realy ecesary an sled for tense ac the patent bathe ‘The eachinglering process empath skilled marae of eahlng. Wen knowledge o Sil rhce edad to the ees of hele inary. Functional los, haat the asec rea ie race ren haencing ie eoable and neceary. The patient may require education about how © Tranage ic ening ies improve of maintain Fucon or handle sinibane ymproms a ro ems Tah Span? Delp and nplemenca reaching plan eco or minimize eh nace ofc defi, ‘ale che patents sponse wo enchig or pogesinlsming, Look fr modifcaion inbshevior or changes in performance hepato witha cant des hil. The nar ecb aire. ny ping on ass nd pant. Tere ate tha ptt co dre tot “Tear atin experiences vere tg ad at intleranc. The mai teaches er Io tormanag the des by implementing 4 sbedale of rear ret and modi cv. ‘Thread ntes improved acy tolerance and les fie Recogoine chat there are ight paramere of eaching needs fr che pane ar home” «Disease or injury igs symptoms, eatment egmen, causative or concburing Fe «s Care and cament: pesonl hygiene, mobi skn elimination, exersies, ADL sndimore «Medications: name, purpose, dosages, side effec and precaons 1 Die food sources how co purchase, plan, and prepare meas Aid or Food eee- cons, spec eating echniques «Ongoing hah cre monitoring requirements and self moncoringechigues 1 Rusk factors: medial idendication, sary, stress, petsonal habs infection { Complication: prevention sgn, symptoms, acconsto ke 1 Environment: modifications to promote opsmalpeformance and safey. “Theres no requlremensharthe parent or family be taught prod servic thy eanot or choose to pond he eae Tn hese sencons, vey that your plan aes the patent needs oppropicy ee Tem “Teton Gaileoe AL ‘Mediate will mr corer visits when the nus sole responiblicy isto each agency staf how comet che ppienténeeds. Thence tbe bumeto tac der hawe ta ase ape lif che les the agency espe sibiliry ensue cae affhae the reste sl, Reteaching and Reinforcement $#0.1.2.3 In derrmining the reasonable and necesary numberof eaching and tanng vss, onside «racion must be given ro whedherthereaching nd eaining provide constcutes lnoree- ‘mene of aching provided previously inaninsiewioal sting oc lathe home or whethe ie represensinitalnsracion, ‘Where the eachng conscaes 4 reinforcement, an analysis ofthe patents retained knowledge and antclpated leaning progress necessary to dete the appropriate ube of vcs. Where the patene needs reiforcement ofthe inctional aching, ad- Aiciona eaching ses inthe home ste covered Receachig orainng fran appropriate period may be considered reasonable and necessary where there isa change in the procedure or the patients condition that requires reteach- Jing, where he patient, Family or caregiver is no properly carrying ou the task. The linia eotd shou docurene the reson that cheretechingo taining segue ‘Balute any siautonimolvngrexeachlng or reinforcement carefully. Asses che patent knowledge apd sls co deni ay defce and its inp on che patients performance or cate Develop 3 reaching pln. Documentation should iden the knowledge or skill deci and che impuccon the patents ie (Consider dhs examples ‘The dlcharge coordinator informs yu that he ie wa tanght wound caren the bsp eon your fs visi, be demas core perfrmanc ofthe wonnd care prctare Docsse sho a need fr teaching reinforcement? ‘The pin bas aon inal wth be right hand ll bis if. He fers CVA wit righ beniplegi. Wil you echo reteach bm bow to antral bis lef band, someting be ha never done? Asyoucan se from dese examples, cher isnoca lear line berween teaching andreteachingor rinforce- ‘ment. Whea Fced with the ise of teaching or renforcing, che intemediry may look abie cose eo craluse whether reaching is reasonable and necesary ro reat the illness or injury. Asses che pat of the knowledge or ldeficic onthe pavents condition develop plan teach and evaluate the rele And wien ic becomes apparent thar the paren cannot lean, even with reeachingo¢relforeement, teaching ceases to bea kl service * ‘Whacabour he paint who hasextensve eachiog needs bu he nurs is nose ha thepatien oem ‘iy beable oleate illo knowledge? Once gun check CMS Publication 100-2 Chapter. $40.1.2.3: Nocwithsanding hac the eachingor aig wae unsucce the servicesfor teaching and ‘ning would be considered eeatnable and neces prior to the pont chat iebecame p> arene thc he eaching or eaining was unsuccesfi, at longa such services wee appropt- eto the panne ile, uncrona ls or njury. youarenorsure, bur think theresachance che patent clear ery ease goal for thestuaton ‘The Bases of Medias Service Davey nSfh and implement aeaching plan. Loa fr any sgn of bchavior modifiasion or small as. eis athe time you reine chat he patient wl ot eae chat eaching ceases co be reasonable and necessary. Focus on Documentation of Teaching, Complete docarentaon wil lp you demonstrate that teaching i reasonable and necesry. Inthe Inia aemene ent the pact neler ll defi andisimpuc onthe pce fe. Since the numberof vies eed each depends onthe unique abies ofthe pcient an complet of hat eng, came the aint ably zo lam and ny fcr feigning When wri ing the eaching ln, eabish elke measurable expered oucomes. Ue stg acon vs which speako where pelea. 00 what you wll ach “Pa wl deibe and pions ef deeded presare’Ne, “at wilde tend high bsp “Pai wil se tines of ariniration for meio” Not, “Patil kbs re Incheviseoces or on tie teaching flow ser, document aca eaching done sng vette or “irc indidnga summary ofthe content. Dab achingmetds wed and prec evaacon ofthe pace reponee Denote the often of eacing dough compare dscns of changes in che pants novlede adsl evel or observed chang nthe pants behavior. ‘Management and Evaluation of a Patient Care Plan Some nursed to cane management and eration ofa care plan wth ee management, ome- thing thar uses have en dog eevee. Management anderauaon feces on safe plenetason ofthe pln of ex for Metea patie. The definon In CMS Palicon 1002 Chaper 7 lps deep guideline fr edly and docmenscon. $40.1.2.2: Skill nasog ve for managemenc nd eration of the patience plan aa 1 sonable and necescry where undying condons or complicaons requ that oly 4 fegitered nase ca case the eset nonsklled care achieving its prpore... The Complsisyof he cesar led servic that rs necesry prof the mee eae ‘mene mast require the involvement of lensed nares to promote the palen recovery dd medi ery new ofthe patent overall condition. Purposes “Ther arc thce purpose for managemenc and eration ofacae plan > » Mains hepa sary in view ofthe patient veal condidon. » Meee he pct need by implemencing he plan of cate correctly. » Promote the patent recovery. Recovery can mean ce or otal comeback oman ‘nes ou. Kean also mean co save the patient from complications and problems snd o compensnte for facconal limiestions. Management and evaluation can help the paent rain and maincin the optimal level ofeach ad performance ee Theteaon Gude—A__ Checkpoints our mporsne checkpoies help you ent whether or nthe paix and services mee the ctr formmanagement and evahtion™ 2» The patient has mukpl medical diagnose or chronic loess, swell asahiory of complications. leis these factors char pu he paint a incresed ek foe problems iF thecateplan snatimplemenced prope » Accomplex, involved uni care plan will include many medications snd eat ‘ments, and implemencaion doesnot rege the sil oF marie Ofen diferent "ypesofcomplex equipment and supplies ae wed in care dlr. > An unstable caregiving sation jeopardes proper implmenaion ofthe plan and necessitate invoiement ofthe nue. The nzablecaeiving sation may be ‘aused by achangng care pln, che involvement of many caregivers (Emly, pevatly hice, agency sf vohincers, er), equentrumover among caregiver or cxeger limutacions (neg slow colar, show compere disregard forthe eae plane) » lnvolemeary the registered murs is absoluey eset co ensue fe, proper n- plemencation ofthe plan, and maximum bese or he paint. To evaluate whether the patenc and caregiving sation require 2 naric kll,k onequeson. What ‘would happen tothispatiene ifthe nurse were notinvolvedin cae? Ifthe carci ces pronde the eae propel and che purposes are achieved, he nares lee not required even chough the sation fll the requirement ofthe freee chede poins, However fhe pstiene woud be a increased rik for problems or complic- tions because of inappropriate implementation of che pla, shen the nus sls re required and management and eahtion would bea sled sevice ‘The patent as Huntington: cares and it experiencing sin breakdown, ncomtinen, oking and eter read problem. The complex until cee plan inde sin are ‘rangers, measures prevent chong, ad a owl rnin Thebans ermal sth cancer and the danger basa history ofmentl les. The asta creoing ta tion rel from the waryingailite ofthe caregivers ta mat the patient neds. There st eine t cordate services, ind and tah ter cargo til when the Isband and danghterconno provide care and mdi thepln, depending ow tecareg- co abies, “The equency of vss for management and evshation ofa cate plan depends on the patents unique sicuacon. Esablsh and modify the equeny as necessary. ro ensure proper and fe inglementaion oF the plan, The goal of managemencand evaluation ise providea sable, ale cxeping ston wiehout the urseinvelement. Continue vis ntl achieving tha bjeeve. When ths objective acheted, visesareno longer reasonable or necesiy. Managerencand evaluation requires the sil of the eisred nurse ro ensue appcoprint implementa tion ofthe plan. Fnusng services focus on assessment ofthe patent detect ely sign complica ‘ons, management and evantion isnot che appropri sevice. Nori appropriate wo cover aden station o prepourng of oral medications or che asignment and supervision of hme heh ides, iF these are che only services the pant requles, “The Baesof Medians Serviee Delve,— Focus on Documentation of Management and Evaluation (Once apuin documencation ri to supporeyour service delve. Documentacion should reflect he four checkpoin as wells the sepsin the nursing proces. » Demonsat the need fr thi srvice through documentation oi ictors pro Jem limitations envronmeneal concems, diagnoses, and hissy of ospitlizaons ‘occomplicton. » Esplin the unstable caregiving station, denying eke caxegves' umber, role limiacon or sles, the changing ace of heer plan andthe comple of niled services, including mediation and estmencs >» Detalhe nace chrogh the care pla oesing on coocladon an comm rieaon ofservices home insrton, and education, aignment, and supervision of checaregiver: > He lice erat performance and afer. and appropri imple- > Incidea speci orde for management and evluationof care plan onthe ln of care. Managementand evaluation mayb the aly servic you provide oritcan blend wich he ther nursing or agency serves. > Tnchde on hea asgnmencorhome program a descpeion ofthe patents lime sionsand sey concerns deals ofc, rols ofthe pane and other ceiver nd paramere for observing nd reporting ignfcane fing co he mae » Doctment sled acing interventions in the Wis nos incding asignment and supervision of caregivers, coocdinacon of care and cormunkation with others ia- vobed in he pases care » Demonstrate the patent response by docamendng he bene reduction of om- plicons iniens, o hospialicatons, and through ongoing ssesment of fan Sonal capac “The ecord shoal show dhe aseationshipand comple of factors resikngin sigh potent for complications; why musing services ace neceuary to mest the patent needs and eo este he pases recover and/or fey in vew fis rhe over condition. I rough documentation in che history tnvdasetsmene you can show the impacto previous discontnuston of ursingserviceson the paints safery or covery. youadd supporto your ee The paintwson entered an a capes melicaion and hin care regimen The devghter wa ber arepiver. Th agency bad extensive docaetton of emplations and rls tht devdoped whe the any bad dota iss rev Psychiatric Nursing §40.1.2.15: The evaluation, pychotherapy, and teaching actvites needed by a patient enfering from a diagnosed peychiatre diorder chat eguirs active treatment by a psychiat- cally tuned nurse and che cos ofthe prychistic nes services may be covered a 2 Aled uring servic... Theservices of aprychiaic nus ae tobe provided under plan. cf cae eablihed andreviewed by sphysican ine “The eacos Gideaa Here are some importanepoins to remember about skiled using services provided by poychiaeic » Federal lw precludes an agecy tha primal provides care and weatment of mental liscate rom parelpating inthe Medicare program asa home health ageny. » Payhiatially rained nurses are uses who have spel raining and/or expeience beyond the basi nursing euriculum, CMS Publcason 1002, Chapser7, dos not derail chi triningor experience. The personne ecoel for ech nurse stould include documentation of che prychiarc mines addetonal caning, education and expen nce, Check with your iteamediry regarding ie rqsremencs and howto mana ad brie the infers, » The ageny can provide the services of prelate ce under plan oF car signed byaphysican. Iie longer necessary o havea payhians sign che plan » The paint must mect he Medicare clgityrequlrnenes. That means the patent must be homebound and neal sled serves that me the qualifying nd coverage citer, Therapy Services (EMS Publication 1002, Chap 7, cuss some of che pips goveming the dlr of led they semees {H0.2:1: The service of pyc o ccupalona herp or peed anguageputhlog a led they sec dhe inherent comple ofthe sevice eich that cn be pefoomed ‘afiand/or fil ony by a unde the paca operon ofa kl cherapi. To be coed che sled services st be reasonable nd ecesry co the tesmen ofthe patient ines or injury oro the estoraion of maintenance of function aed by the Pate es jy. “he development, implementation, management, nd eriuation of pain cae plan ted on che pyar oners conse sled heraysevcs when beau ofthe pens ondton, chow aves require the involvement of alld therapsto mectthe patents ‘needs, promote recovery, and ensure medial fey “While pain pasar medial condion i ill fico in decd fled cherpy servicer nerd che diagnos or pognot shoelace be the ole fcorin decd hat 2 eres ori lle. ‘The kyle wheter the ils ofa therapist re needed treatheillns or injury or wheter the services can be cid ou by none penoonel “Theil cheap service mare eatonable and ecenay theese of he pace iso injury win che oor of the pres unique medal conden ~The eves nus be consent with the nature and severity ofthe lls or lnjy the patents p= tae medical neds, nig the eqement dh the amount, fequncy. and duntion of serves mst be extonable, The sevice mst be considered under cepted sands of tneical practic, o bea pei safe, and effin eatmene for che patients conditon. ‘And, che erie mat be provided wih the expection bed onthe acsmen made by the physica of che patents eabkation prensa the condo ofthe pain wll ‘The Baicof MadiareServeeDley 7——A=. improve materially ina reasonable and generally predictable period oftime;or the ervices ‘uc necessary tothe esablshmen ofa safeand efecve maintenance progam. Services ofl cherie the purpose ofceachng he patent ami reapers nay ech, sinus execs or pecans ar cover othe exe atheyarerewonableandneesary tothe ex the ines o jury Basic Therapy Principles (CMS Publicton 10-2 Chaptr7, ens our broad cxpoi of dled serves » Assesment identifes and evaaes the patents ned for therapy, he rhabltaien seni he impact ofthe therapy plan. and any potential danges or adveecccs “Therapy assesment should incorporate the appropriate OASIS das clemenns » lille procedures inchadehos ervices (procedures exert eeament te) tht ‘equi the sil and knowledge ofthe eheraput fr safe and effective eur, Can che Procedure be performed fly ndeffcel onl by the sled cherpia? » Teaching the paeno paisley, techniques acces, and pe Ccusons which ar ecestry and easonable othe weanencof the Unesor ny a shld sevice. Te therapist should idee sll or knowledge deft chat he or lmpacton the parent’ performance and fanction. » Management and eralution ofthe care plan saskiled service when thos active {involve he lof cherapia to mex the patient's neds, promoee recovery and en sur medical safe. The therapacons promote the patent recovery analy ‘Biintermedary ube coverage decsonson the patent unig nec for he therapy rg, it though a thenpyocned diagno is pl isthe pace unigue ned for they er {fe mos imporan: ctor in deren cre. To show ha services re resonable and nctery de cline ord shold idan the pas fancnaliniaoasin acces dying mod ‘etch lnguage-communication, and sary factors requiring sled inerreuone The Condivons of Paripation requ che agency co provide services unde a plan of ee esablhed bya phyican Era your sar permis ome lee of independent pac by thepls h pln of Suet nde pes orders therapy serves. The therapist muse obra physica nde foray ‘evisions coche plan. Medial evi inthe PS focuses on therpy services. Providings, 4 020 vss a an cpode in ras the agency payment siglcandy. See page 2+ 1. To aoid problems, py conte enncog to therapy services fo enue tha sevice a sill resonable and necasary nd povided rds Physician plan, Restorative and Maintenance Therapy CMS Pabltion 1002 Chaper7, seas torr rype of chepy:rexorate they eae -ovard “eoremens nd maltennceherapy designed eo manana fncdonat ik. Fr wstote Cay, “here mus be the xpecaton tha the pant’ condition wll improve material tna resonate Benet Pticabl period of ime” Descbe che paseeslevel offancon before he las or nryo ‘seals a baseline fr comparison anda rehebltation poten The prior level of uncon on alec a 2 Maeneonnnnn---—fA_ ‘OASIS daa cements can help document this information in some situations Esablih an expected ‘curcome tat eres with the pant poteneal nd demonstrates mprovemenc rom that previous level ofpeformance. Then dlverand documentcar, ning objecive nding, 1h pains recovering from facture ip. Before the injury the paint amblted inde pendently. An expected utr hat creates wit hepatic ebabilaton ptemil and denotes the execstion of improvement would by, “Demoitraendeendent able ‘ior wit cane” Avater pases, alo recovering fra faced, ben confined to. whee for fi years, In thi ese, pprigrste expec eco demestrting the epcton of r= ‘recent wold be, ‘Demonstrate indapendet rane from bed tc” (CMS Publeation 1002, Chaper 7, Its many acevtes covered by Medica bu it annor begin ro rmencionthemallleshould be cla tha ay shld eherpy sevice or atv parormed by the ther requires spsialned knowledge and sil. IF chat parala procedare were performed by an nsled peson,thepasene woul be ak fo injury Restore herapy dermands thatthe paint demonstae progres. An ageneycan fice denial of are forcoocimued vss bya therapist co perform repexee exercises if thee i 0 aogreson or improve ment evenif he ie reque hells of therap. IF ce pan expeiences an exacerbation ofan old condiion, analyte she pri lee of performance, the degre nd cause of limitations in Function, and siguicance of the change onthe patent if, The lanned iervecions must be neces, easonabl, and appropeate Fr the exyected ehbilacon po rear, Remember you masespcr tha the paven wl improve matrlyinaeaonable and generally redicablepeiodofeime. ‘Maintenance therapy should help che pasen main funcxion and valve the we of complex and so- histcted procedures aswell sche therzpis judgment and kil. The recoed shoud deny the pat- ‘cular Funeton ar skand show thar che pogea requires the sls ofa cheap. Foca on safety and Fecrvnes “Thereareewoyperofmaincenance herpy: The fstone legenerllyshore-ceam. Tether rlutes che patent ned esablcesa home program, and teaches the caeyiver how w peform dhe exerci “Thesecond isa program caved oucby the therapist “These should not be services thas home health aid or fry caregiver could pecform wich out ping the paenc ate ‘Th patient bad mip sero, was confied oa whee and ire fom patty, ung rae dat and uae Arar oft maintenance tery pega th py caltbrspia performed exer wit th patienton tear exerts that and nly Be per fore aly and fect by the peal herp. The program rina th patient “fei and rng ber fly con care for era ame. fhe paen had cheipy while in che insiution and now requires home heath cheapy, Focus on the patents dec within chefhome envionment. Can che paint perform at his o:her opeimallevl in che home evionmene the pavenc needs therapy, does the plan ncode neces and resonable actions rose pacenin easing ths evel of performance? ‘Be patent bad pic bers in the martin ome and wa independent tale trang. “Tretia of Medios See Daveryeet lowee at bedi at ase an eae et orgrabber and be web did nt fin the baron As a el be could nt ram independently a ame and cod bef from tery. ‘The intermivene creado nor apply co therapy services, A cherapit can kes singl vs fc indades ‘he delivery of reasonable, necessary and shilled service. However, the challenge in proving that one viscisreasmableand pecesary. Se page t« 12. ‘Therapy Assistants ‘A physieal heap asstan or occupational therapy itn can provide Mediae-covered services un der the supervision of qualified physical or occupational therapt respectively Education and super sion ofcherapy assansis che esponsbliyofthe agency. Seepage I» 6. ‘Therapy asistans are eognined a providers of sill services so Mediate can cove the at vic by a sherapyasssant oa paen. However, therapy assent cannot complete OASIS assssment So che therapy asian makes the asc bilible vis, the agency wil either have vo senda nurse within 48 hous ‘0 comple the dichuge assessment orusche ast visieby a quale clinician (eiered muse physical ‘or occupational therap, or spech-language paholopst) asthe bats of che discharge asesmene This ‘mayhave an adverse impacron the ageneys outcomes, The psc hep admit the ptient. Tepe tery aisan providing crt fr ‘he met tree wicks aed the patient moved nto ate, Ther of care st by the thers wou be be bes for the dcarg sesment. ‘Te avoid his sination, consider case sharing sign the cherapist ose the pasent once a week or com lececvery chil orfouré vise Thar way inthe even of an unexpected discharge the discharge ascament dreawould be moreeurent. Not: Thisalso apples roan LPN/LVN providing sled mang cae Focus on Documentation of Therapy Services ‘Song and fei theapy documentation begins wit teil assesment and evaluation. This io- obs the organzed alton of clinical indng and dato exablsh a budine and suppor the Hen fed problems. The asvementis nota routine sereening,Inchide these imporant points ofinfoweaion » Lis: pernentmedicl history, including the date of onset for anew condition ofthe dae of exaeration or deteorion fr achonic condition » Kenly the ype and dates of srgeryo previous eatmencs Iter tno supporting ‘herapy diagno densify why dc paces cad crap. Lok the pace hisory and the impac:of the problem on everyday fanedoning to usify medical neces. The pains trminally i. Shots plc ery nl each is wife bw pston, sre and exerci her hand. » Describe the patin’ eel of performance before the lls or nur toes a ‘exoratv poz. This eorative potential juss che level of tems and ag. sresstenes ofthe neamen plan, and eablshes basin for fare enlacon aint progres ‘Yep a dace insracr before acting bcp, his reeaine or resoraive “The Bescon Gide—A__ otis ceranly ber than pen wh has ben smn 0 wher for Ojo ‘Ure objective measurements and appropriate descriptions » Physlealherapy. range of motion (ROM), srengthandendurane mus one gal, ‘ransfrs, postu, pain, coordination, spastic, conmacuc, we of equipment and! ‘orprosctic devices orenvronmental aris. » Specch-anguag pathology: time, money, and number concepts, funcional comm ication receptive sil, expressive sls. For pant receiving dysphagh treatments, ‘ena the lv ofalerness, motivation, cognkon ateion span, delaition, any problems wich piri, incoordinaion,sensuion asso exiwence of ther cond tions, sachs wacheoromy abe » Occupational erapy- percepral, visual, sensory. and cognisve bites gros and fine mocor sll, incegratie skills performance of accviies of dally lirng (ADL), sensation, bilan, quipmene or environmental sary. Fancronal limitations in mobi. civics of daly Iving communication, and sey describe the pa- ‘Bene ned for therapy by emphasing the impac ofthe les ordfce The OASIS data laments guide the comprehensive assessmen of hese limiacons. 2» Mobile: imbily to use ascve devices liieaons naan, ambuliton or po- sSioning: weakres, or Exige. » ADL: limizacoasin ding, eating, dressing bathing grooming, ortoeing » lngrumenta acivces of daly living (IADL): shopping sundry, meal aeparaton, housekeeping, abiliy couse he eephone. » Communicacior: expresve or receptive sphas, limitations in reading or weting ables, swallowing difelies, » Salen: high sr ili injury, infection; enveonmeneal haan lackofavareess fsalery concer. (Cay the restorative needs hrough neo he pln denying spect goals oftreatment. Coordinate the "ypeand frequency and duation ofinervetons to the degree and nature ofthe problem, Include spe. ‘lie modalces, number ofrepeions amount, equipment, activites ee. Interventions should rele ‘ccionschacony a therpistcan perform safely and effecivey. Watch for duplication or epetion of vices, Develop and each abome exercise program. The home progam provides gudance and instruc ‘on forthe paiene and carvers. Evaluate he pacts progres in relclon tothe estortve needs ‘este nores should include ae ongoingassessmene ofthe paren condition the sill servics performed, andthe patent espome or improvement, as wel say revisons nthe plan and comimuneacon wath other cuegiers. Include: » Anassessment ofhe paints condvon, incorporating significant clinical findings vo suppor: he conenuing need fr therapy » Asacementof te paints axivt vet jusify homehound determiration, » Deliver oflld services Inervetions should elec acon tha only re cherpst can sel and efecively provide “The Bases ofedicare Seve Davey Taleae If) 2» Measurement of progress refecting back to che baseline ad Forarmainenance progam, spesto the ptient continuing ables as ares ofthe Program, Functional Limitations and the Presenting Problem ‘Aller you hve gathered the base data, Kena the pen spec problem in tems offncional liaions.Fanctioa liieason rane che patients slgs and symp toms ino problems tha describe the lmiations of performance and he mpact of he problem on he paren highlghing the need fr chery dency the medical e- ‘logy ocontbuing factors to demonstrate the medic neceity ofthe interventions. Functional limitations answer the So what” question. Te pat he dered range ofmaton in is es. So wha? Ss be canat and xp witht aitance. These examples show how you can szengthen general findings ehough the wseofpecicfncionl lain an exology Limited mobiiy Cet abate bcs of pain eg Impued ADL Right hemiplegia, cant dre lf Inpscedcommunicaion —Expresie aphasia duet CTA. Medical Social Services 150.3: Medical social services thac are provided bya qualified medical sca worker or social work t- sant under the supervision of: qualified medical social worker maybe covered a home heath services where che patient mees the quilifing critera.and the services ofthese professon- alsare necessary co resolve socal or emotional probleme that are or are expected to be an Impediment tothe efecve treatment ofthe patients medial condton or his or her rae of recovery; andthe plan ofeare indicates hv he service thas are eqied ecestate che sis of a qualified social worker..to be performed safely and effective. Services of these professionals that maybe covered include, but ar notlimiedo, assesment of ‘he social and emotional factors relaed eo the paint ines, need for cre, espnse to eat- ‘ment and adjustment ro cae: assessment ofthe relationship ofthe patent medical and nus {ng requirement othe patenshome section, nancial rerources and ralbly of comma iy resource appropriate acon to abun arable commun eure asin vel, the patient’ problems: counseling services which ar equied bythe paren; and medial social serves farnished tothe patients family member or caregiver ona short-term bass when the agency can demonstrate thar abi incervencion that ro ro thee vis) by a medical social worker is necessary to remove a des and direct impediment tothe effective extment ofthe patents medical condition ot his orhecrte of recovery. dial social services can bea Medicare covered servic fhe paces experiencing socal (conomic, ‘marc ewionmencal rc) and/or emoconal problems that in the jdgment ofthe physican, ate ot ‘ould be an impedimeneoefetve weament. The services marque che sills of «qualified medi- «alsocal worker. Treatment codes describe some ofthe specks of coverage criteria andresponaibies ra “TheBescon Gide* (Eiimunicy source planing includes pen edvconon, sdvocicy, rer and linkage co communi sevice, * Shorcterm therpy or goal-oriented intervention asinsche ten in adjusting co along com ile or dbilly, manspiogs tema erengehentng che fay oF sports, or rsohing confltee » gt cerics ested under oder. indade he ses ead she poients See Si tein sions ena irri a pea esolisen 3 cron th si empl ide Metuenenng eee Focus on Documentation of Docameneation muse demonsrte the cane eumenceofth prom on hp i Eras hon aegis, Apres reams and walle rious, woking wih the any esa j ‘The Basis of Medic Save Demag re IA. thc acons or scationinterfe wich safe and effcive implementation afzhe plan or the puents recovery. » Develops plan that inclades measurable elie goal. » Impl sled ncesentonsas deserted in che eamene codes including coun- seling, community resource planning, and shoreterm therapy » Erahaceche pen’ respons, erring the impact ofthe problem on the patient’ if asingcomparavephrscologyas neces. “Medical socal serves ia dependent service, The agency can provide che service only at longa he ene quai or Medicare coverage through a need for nemmien silencers. or speech-language pathology, or 3 concinuing need for occupational therapy Medicare wl noe cover Aependene services fuished air he final si ofthe qualifying service. That meas sty medical soca services wks made afc che ls ualying skilled nursing or therapy vie we noc evered by Mad cae The one exception: IF the qualifying skilled service could not sex the pacen agin because of an unexpected reson uch as adie che opal or death, Medicare woud cover dhe av by 3 dependene service, Medical soci servis salvo dependent in one other way. Iedependson othe dips support its ‘ase. Ifthe parlene especences emotional or pastel problems that impede the elctnenee he plan of care other dcilines should document accordingly co suppore medied soc sevoes Themed oil worker isseing the patent bot noncomplin withthe are rein. The led rig rts bold shaw abject facts of encomplance “Wei gain of foe pounds in tree day. State: bei taking the dei? "Bbad gcse eaated. Wiese be seakng choclate” ‘There have been some concerns about che intial assessment vise made by the soll work, A CMS lteiv dried th iu. “There must be documeneacon of a elaonshipbrween soil poems ‘and che medical problems for services co be covered. A sail work vise reabursble whea'ye ashes ‘eimbursblsocil work aces areca our when physician has docuested chat ool pene ‘ist which ar or wil bean impedimene «othe pacenes recovery Home Health Aide Services $50.2: The services provided by the home health aide mut be paresime or imermitent., must meee ‘he defiskionofhome heh adeservices.,and mustbe reasonable and necesary cothe rene ‘mene of the fatient illness or ijury. The eaton for che ves by the home heath side mone beso providehands-on personal care othe paint or services tha ae need to manta he ‘patient’ heath aco facia reatment ofthe patient nes or injury. The physica’ order shoul Indica ee fquene ofthe home health side servces required byte prtene Home health sides who provide services under che Medicare benefic must mes he eirement esab> [shed n he Condens ofParcpaton inching basic competency and ecg, inservice tang assignment and swperision, Seepage 1 «56. ‘Home helt ade coverage underwent dace changes in 1989. Prieto tha tne, if the aide di noe pero and docuren: personal care, Medicare inermediarer determined chat tes was not covered i an Ga—A. Now: Mata coves thst spams non penal car OR sevice wih ‘xeteamencOR ves mae et Ron cae es + bsg desig rooming ic olin having. sce ec cae and endo apleion + Reding + sane wth liniton nd exomy and clan bags and + scan wh anbaloncans sn changing poston nbd. Sere hich ti emt rman el inde + snp desig change ht donc eae silt of nae + sane wih medeaon which normal admin (sae by the saeco ec pa) + ssa with hme thy roam hat dos eee ches of hen, a + eof prone or onde deve ‘Te ome de cabo prom omens servic dtd cmt dno fo xs sis flight deaning or pepron as me tha se bef te nee an oer he purpose hve mbm rv pena cores camer ‘inna Noth Mater wil coerhome heise ifthe ae sewonc and aces othe we iment ofthe pate’ lines, uy ton lo. Make conection brn he sents fexeand the eisyou prone eect poviingeoanlcaredepaoen elton, sco ingatediyin pertorning ADL ad LAD snd hemp sey ds ee ess oxinpry ‘Pe pte has pare piel ily bee ace, ald reir sii sian wth rae: Or Gece hei hale san ie, tomy aches Tk quency and duro fs conespond eo he pend nd degre flan in ADLandIADL Apt an rc dly ie isforperoalar Sabai stem coe sschaparteank and fro een tary rng Merton oncg, porter pct deere Jarl metal tl eres hom ahi ervceisadepenen ei. Se page Ie Focus on Documentation of Home Health Aide Services In che intl assessmene, describe the pint imitations of funetonal los, reason Free limitations and ope of asixanes eae. OASIS data cements On ADL and JADL help suppor the news of side services. Ongoing asessmenc and documentation should include specif descripons of the pten functional tans abies, and liftatons tht suppore the continuing need fr astance, wellasadescrpson ofthe impact ofthe service on the pales health and ability Fanon ‘TheBass of Medicare Servi Dalvery 6ati Tchad in Lcaror21 onthe cat the equcncy and drain ofthe vse and the typesofsernces heaide wll perform. Documene comple onderforamytretments the ade wl perform. Use the cat ‘ment codes asche bast ofthe physicians orders for aide services. See Appendix C. Horn belt ade 2 we 9 Bathing peonaleare. Administer Bad epstiry a Mi days Soa fen warm wate for IS minute, apply Lotiane area een ee. Develop spec sgnmenc forth homehelch aide, nding the esponsiles ofthe patient and fam- Ay. Spl oe che speis ofthe physicians order for personal car, etc, bathing and sia duties. ‘Addres the patenliniaions. The home helt aide mis deliver and docurmen arin keeping with the signed dies, and record and eporsigificanc informacion. ‘Supervise thehome heath aide approprite, Seepage I+ 58, Te Bescon Onde——A__ Medicare Noncoverage pacens mus receite adequate informacion abou the ancl lib for care when Meare ‘overage arse, The beliefs char paints should hare the opporanity co choose for them selves whether trecsive care hat maybe noneovered, to desde how copay for eharcate andr question agency decisions to terminate ee for zeasons of nonconerge. A the sine time, provides also have righ and require proceetin elated ro nani bili? “he BNI broughe about wo new proceses for noifjing a paint abour noncoverage of services by Medicare or changes in paven labiley. These proceees are che Heme Health Advance Beneficiary "Notice (HHABN) and expedited determination. HHABN “The HHABN isa writen node char the agency muse provide o& PPS Medicar-lgble beeficlry when ch agency believes Medicare wont coversome oral ofthe sviesthe physic hs ordered (ere ‘fers coverage under another pays) the ageney cannoe provide fo # own reasons the onezed er- ces, or there physician-ondered reduction in services Tht ira diferent open box ot version for cach ton. IHABN Option Box applies when chereareconcers about Medicare coverage. An agency mute ‘his nocce info dhe patine thai beleves Medicare will no cover some oral ofhe services and/or supplies th phyaetan har ordered. The aggring events for norfecon include: » Iniation ofnoncovered sevice to Medicare paces lige o receive services un de another payer, such as Medial, surance, or pice pay » Disconcnuaion of Medicare-covered services because of concems about coverage. » Reduction in the number of ovred vss provision of supplies because the agency believes he number ordered by the physician i not exonableand necessary. ‘The dinician completing HHABN Option Box I mus explain he reason forthe decision and incudean ‘cme os ofthe services and/or supplies. fer eeiing the noe che patient as thre option: 1. Ref services, 2. Receive serves, agreesobe personally responsible for payment and noe ask he agen ‘ytosabmita claim insurance or Medicare, 3. Receive the specified home health services, agree co be fll and personally respon- ste For payment, and ask the agency to submis sim eo insurance or Medicare, called demand bil. HHABN Opcion Box 2 applies when che agency cannot provide servicer forts own ressons, sch Inadequate selfing or concer shou staff tlt nthe home Daring ait be herp ses evidence of de and gn related ates curing win {hebore. Afr atemping to work thang te mation, he agency determines itn longer eaefor cava he pains. ‘TreBases of Medicare Service Darery 1a T: Beneficiary Notice: Iie (BNI), exablshed by dhe CMS, dhe vel of ounces daesh “This noice informs che paten shout the agency’ deislon and gives him or her the oppotusey seek services romanothersgeney HIHABN Option Box 3 wil likely be che novice an agency issues mos often, The wiggting event isa ‘Physician's ener to redce services tha was not ound in the orginal plan ofa. Thiscanbe areduc- ‘on inthe fequency of Mediare-covered vss or che discontioacion of one disciple whl one oF ‘more continceto provide care The pain wa recving led maring sss thee times a week and bre belt aide oie 11ch. The psa dcotinued bom bel aide ero in th third wek. Dar he Sith ech, the plsician eed the requeny of aring vo tke a wee, Bath fase reduaions rigger HHLABN Option Bax 3 “This notice alo applies when che physician orders a eduction in che provision of suppl (how ofen "he agency provides chem, not che number of supplies used fora gen procedure or diceninustion of supplis. Medicare wil sl cover necessary services ad supplies, only at aleser eve. Thenoccesimply Informs the pcene tha she agency muse make a change because of physician odes. “Appropriate Application of the Option Boxes Reason for | Option HHABN Box ‘he agency deermines | 1 | The patent as tras opions rele wo care and franca Services tobe provided libiliy: may choose not rece the te aod wil aetbeeotered, servic in ueston or my choos to py patho ‘eventhough ordered by may accept ably fr paymet while requesting at the the phyicsan gency along bil Media forthe sernces, Description Tre agency makers “Te ageny infor the pe, while wl no ger thine decson pode eves, Mecca coveage nt ates tedice cermin {he paen' may ty to obi the sevice fom ancher tomes wero. (ack of emerge The agency fore the patient tate pysicantas ‘ted wtackat longed te plano ae and he agency cra oide Prac. the sevice wht pyc ores sel or tah edcon in frequen and dicotnaton of Gcpine and when ber ae change ode Po Piva nes Repel low HELABN and Expedite Revi: Managing Dh Pro Homecare Prviee ‘Tere ae exception to ining che HHABN, Thee lace an ncese in cae a was to another heath at provider, and ceminaion ofall ae with no services concnung. Is ot neces ose an HHABN fca mised visebecaus hiss sone occurrence and not a physian-oneed sede tin in servies Expedited Review “Theespeded view proces is he vehicle the Medicare prenemay asco qucon rd pes an age: ey decison to dcootinue Medicare services. An agency mus noc patient when i rrerminatng TheBeson Gul—_—A. all Medicare sevcs for coverage eacons, The agency hat deerined tha the pases no longer eal ‘es for Meese conerage oF doesnot nec sled, reasonable or necessary serves. Ke does mater ‘che orders have ended or the physician agree with che dicharge decison. The paine chen as che Tighe w request ar epeited review ofthe noncoverage decison by che Qaliny mpronemen Organi son (210). “There ate ero note Involve cape rerio +» Novieof Medicare Provider Noncoverage (CMS-10123), ao known athe Generic [Novice The agency mast sue this norco every padent whose Meier services ncening fr coverage reasons, Notice not applicable fserices endfor cher ea sons. sci as the paints hoped or moves ou ofthe agency’ sericea. » Denil Expaniton of Home Health Noncoverage (CMS-10124), do known a the Derailed Notice "The ageney complete and provides copy ofthisnotceco the patient and the QIO when the paen has requested expedited eve. Herefeabrief overview ofthe expedied review procedure >» Acdncian issues che Genesic Noice at least ewo days before dhe paren dlacharge Fiore Medicate The efecsve date on the novice i the day Medica services wl od » Hflochage happens unexpecedly eg, che nare discon che paenchasrecumed 0 hispuesime jb, a clinician tsuce the Generic Noie a soon as poss afer lear inguboucthe noncoveroge. TheefTcive dat ithe day the paren no lnge quai, ‘nbichmaybe te same date the agency mir the node. Ingharcase, the agency mist ‘lea: ease ewo day o proces the discharge claim o ge che pain the righ 0 requctexpedied review, + Before requesting expedited review, the patient mast obtain physica eration decing the she o she ficesif homecare servies are dicontinued. > Afieresvinga rues forreview, the QIO informs the agency and ees the De- talled Novice and documentation fom the clinical record. The ageney must provide *hisiformation by the cose ofbusines on che day ofthe request. 1» Theagency provide copy ofthe Detaled Notice co che patient. » Within72 hours che QIO makes determinason. Ifthe QUO deermines char Medi- care vill not cover ongoing cae the agency can procecd with discharge. Ifthe QLO ‘decd chac che patient teat isan serves should continue, he agecy muse derer- ‘mine whether tan provide cate and then obtain che ncesaryphysican oder, “The exepons ong the Generic Novice include: che patient tanses co arather agency or heath care provider, che paint refses services or moves ou ofthe agency service ar, and che agency isnot able to mec thepients needs Issuing both notices “Theels onetime hacan agency wil nec eo isue both che Genetic Nie forepeieed review and che [HHIABN: All the patien’s Medicare sevies are ending fr coverage reasons andthe physician hat ot- dexed conning cate. The specific HHABN opcion bo wll depend on che agency's response. a a ae “Tetacrof Nellans SerieeDalieny ferry! fia | 2» che agency able co provide che continuing secs, should isue HHABIN Option Boel. This moc gies the painc the igh to decin or acep services. F | scceptng sevices, dhe pane wil sume lsbly and can requesta demand bl. 2 ftheagencyis nocableo provide services forcsown reatons should isue HHABN Option Box: This occ inform dhe paene that he o he can seck services fom i another sgecy. Compliance Tips “Tro proces ct challegs, and omevines conic homecare ens, However hee ae quemenetanageny mscner: all hsp wheneeyouconfonesorercge acon » Hen the ain tht Metical noc coe te servic Rexonsfosoncorege tnd he pte: noc homehound dor the eves ae partner et tent eaable ad cua of dled | » Donen ckcumnes.adde enough spec lfrmaion olsen 227 hie-pryrevener che agency made he noncovergedecon. + Dish econ wthan gay mpervsoe + Notte pin abou the oncoege decom »Talwth cc pten abou the noncoveage decision. Expl she opns carly sndanwe he pacers ueons, Decne wheter pan wan conus with bores teers cep depen or popmee eter pene ot through ander pye | .» Know when and how to issue the notices. Find more information and che notices at srwemshin gov/BNL » erm the apoptotic propa. Expl he eon for oncowageand he I Saree anc cclagn OTE gen my tele for erie fa roves deeemined co be oid + Kepup tod withthe BNL There hae been many changes and ehermay be mote inthe furure, To “The Bescon Guide——A__ The Conditions of Participation ‘order w achieve cerefcaion a a Medicare provider of ome heath services, The agency mist demonstrate ongoing compliance wit che Conditions of Participation inorder to receive pay- mene for series rom the Medicare and Medical programs. ‘These Condon apply co all pases in « Medicare cerced home health agency who receive healeh careandor prional ae services without gud to payer source. The Condionsareincended toensre he heaeh and sary ofpatenes. The agency must provide services thal help the panto aren and _mainain the highest evel of health and performance, gen the consualns of the lines or inary. T: Conditions ofParscpstion describe the requremens& home health agency mus meetin ‘Understand the Terminology Condon: A bro category adresing » major aca of compliance. sch sled runing services or che plan of cae. There are 15 conditions in che Condions of Parson Sandan. Acomponentf the condivon. amore specifi regulation, There 56stan- drs within che Condvons. Fo example widin the onion on the plan of care, therearethree eandards: component ofthe plan, peredi review, and conformance wich physician orders. Guage A federal deneicton umber for separately surveable points of compl ance within the condions. The G-ags for the pan of ee a G156 dough 165 and Gon Iocrpeive Galdlines: Guidance eo surveyors. The guideline include deinicons, ‘ncerpestion and probes. The State Operations Manual, CMS Publication 1007, (Chapes2incdes he lnerpeeie Gldlines along wit nsracions forthe survey. “This chaper focuses on those steas chat have the mos Impact on the standard survey proces and high ligh some ofthe oher conditions ales eae delivery. + $486.10, Pane ighes + 48414(g), Cooedination of rvces + $484.18, Acceprance of paienes, pln ofcare, medical supervision + 4843, Sled aursing services ++ 48436, Home heal aide services + 48458, Comprehensive assessment of iets + Otherconditions: Compliance with laws regulations, and acceped standards ofr, provision of therapy and medical social services and clinical records ‘The Bascsof alae Service Davey Test—fA_ Patient Rights “Thera si sandards within hs condon hat gid cre delivery. Notice of You mp actively procctand promot the rights ofthe paven throughout the process fae deliver. and char begins dig che admsion vs. The admicing clinician must nfm the pale ofthese rights, prioe co the niaton of er. Your agency should have a stem of thts anda policy thac governs the notiesion proces Before performing che comprehensive assesment, the admicng clinician muse provide the OASIS pri ‘acy node dale, nonmatemity pains receiving sled nursing or cherapy urder Medicare or Med lead and nocfy chem about thee peivacy sighs regarding OASIS da collection, Thee include the righeeo: + be informed thar OASIS infomation wil be collcred and te purposeof collection + have che infosmation kep confidential and secure + be informed thar OASIS information will noc be disclosed exepe fx purposes al- lowed by che Federal Privacy Act + reise answer questions, and + sz review, and request changes inthe stesmnent?” Know and fellow your agency polices regarding sessment and OASIS daa collsion. Seepage «3. Patient lability for payment Prior othe inition of services, your agency must inform the patient about ny pepmenc expected From ‘Medicare, Medicaid or any other federal fnded or aided pogram, and any charges the patent may face, The agency mus lso notify the pant of any changes in payment source oily orally and ia ‘writing a Soon 2 possible bur wichin 30 calendar days ofthe change. ‘A service or nancial agreement play an mporane ole in naling patents in alvance about charges sd liar ac ear of care and when cere are changes troughou ere delivery. The service apeement shold note: + the extent co which services wil be covered by Medicare, Medicaid, o my ther fed- cal finded program + any charges that Medicare wl nc cover «+ any charges ha he individual may have to pay. and + disciplines che wil furish care and che proposed Kequency of vis, ‘The HHABN and/or Generic Nocie come ino ple in Meise noneoverge sian. See page Exercise of rights and respect for property and person The patenrha aright cece high no hare propery eared wih pect. Recognte and spect thepencrndviuliry ad csi cr acon) Keow youl eeting dines Sigg complains: "The Beacon GaileA Your agency nus provide ladle patlens wich writen informasion about cele igs under sete w ‘omake decisions about thee medical care, accept or refuse medical or surgieal eatment and formulate anadvnce diecive Your agency mut slo give the pasene wrcen information on how it implement an advance direct “This dcuson wich the pane usc occur ding the fst vis, prior heiniation ofcare. The cin cal record should note wher oc not the paent has excouted an advance diecive. the patient docs hse ane, there i no requirement hae the agency obtain acopy. Hower is helpfil to nd our what the patent directiver are. Agency policy should addres when and how raf update the pasent advance Aicexve sara and hae co do ifthe pasen revokes dice. Right tobe informed and to participate in planning care and treatment “Tce are many way co help che paint parcipac in care planing and delivery. Indvdualze and modify are ro met the patent unique mental or physical seus Ak for and incorporate the paces suggesting cat, erucrring the pacenc role to che evel of pecfrmance. Explain cate outnesand Inform the pane ofchangesineatmenco schedule of vss. Confidentiality of the clinical record ‘Confdencil rermenc of che pacentr dlink record sential. Learn about the ageney polly for handling, eansporcing, and releasing proceed health informacion (PHI). fing a econ doce rmentationsjstem, abide by che agency procedures Kyou leave aalerin she home, props bel eas confide information and explain the purpose to the pasent nd Fay. Home health hotline “The agency mue provide che umber of che home health hodine to che parent ca we Fo eepoting complain tlted othe provision of erviee. The agency sextement of parent ght presented co the penton admision shoul incorporee the number Is goodies co advise patient about how they «an role any sues calling che agency fist. Fr instance the amiting ure can provide he name and number of supervisor che patent can cll dicey Focus on Documentation of Patient Rights Docunenation demonscates che agency’ ale in promoting and protcing the pain ight Inco pvc i nputan poised » Record ay Feo tha fcr the pase undesandng oe ofthe Highs, andany objective observations pent response, Onaiisin che patent wally ‘ign copy ofthe xacement of gh o frm acknowledging ec ofthe at tne nda copyofcheservceagemene » Incorporate pale cneted ole into the care pln core he past papa don n che proces » Docureneall pene eching and he pace epome. » Define te paint ol when woking shame program ot home heh aid asin ment. Not the patients jective response roca ‘TeeBaier of Medicare Serve Dlvery 1s=——__ » Document nication ofthe paren abou any changes i che plan, reacmens ede festions ori quency. Coordination of Care (Conditions of Participation, §84.14(g): All pxsonnelFumishing services muse males also co sure char thei fore ar effectly coordinated and suppor che objectives olned in the plan ofcare Coordination of services mus ensue thar all xm members work egether and with he parencco help achieve outcomes. The mos essen componen of coordination itil, eective communication, ‘Coordination involves the nurse, eam members, on-call personnel, pant, Fan. physian, comm iy resoures and others. Care coordinacon can include meings, ease conference, edephone cll, refers, revision ofasgnmencs, and education and supervision of personne.” “Thissandard mandates the agency co end asummary report cathe physician atleast onceevery 60 days, but does noc specify fy required form or fcmt. The summary should bea complain of igficane ‘actors abou the patients otal progress. Some agencies incorporate a simmary paragraph nto che plan fate, Theagency can also we aspect form or summary por. “Thereate sete rsporane coordination checkpolns + Gather baseline dara during che refer proceso help idenely che paens ees + Asses the patient’ neds aed begin planning care ding the admission proces, + Work withthe pacen and Fay oidenafy neds, goals, and pla, + Communiae the plano sl members the eam. + Fellow up oa paiene cancers and any change in condition. Notify he physician and others vole in are and docament according. + Follow che gency’ proces for recertification of che parent plan of care. Whe re: cruses the patients need for care? Who ultimately makes the devsion to receeliy the patent? + Conduct cxse conferences, following the agencysexablihed parameters and pro- cedures, Conferences are an excelent way t0demonsrate coordination of verices, however chey are noe mandazory. + Develop a specif, appropiate, individualinedasignmenc for cc home heahaide. Communica the patients asgmene and needs, Educate and supervise the ale so care mees che patients need. + Exablish sound pocedaresForon-call decision making, Acceptance of Patients, Plan of Care, and Medical Supervision ‘The Conditions of Pacciption define the esenial components ofthe plan ofa. The pin fare or homecare pains, commonly ferred 2s the CMS-485,conmainll the necessary components ofthe plan of cae ans used fr cerecation ad recertification of patents, These components aclade Allperinenedignoses Types services Natrona requirements Frequency and duration of vice, Thelescon GuileA Medications Equipment “Trearments Progeoss Funccionalkmizatons Rehabilkation poencia Axis pene Insructons fo timely discharge or reeral Safey messes ‘Any other appropriate iems Mencal ass ‘The plan of care is incomplete when ineprct information i ising, uc asthe site and fren for wd care ect amount of fidforapatienton a retried otal, or a dig thet decribed documentation as fein De patient plan. “Thiscondition lio sete thatan agency muschave orders forall he care provided, and aff shold com- ply with the physica’ orders for care delivery. (Conditions of Participation, §484.18(b): The physician and agency salf review che plan of care as ‘of athe severy ofthe paien’condiion equ, butatleastonce every 60 days. Agency staff mse pomp alert he physician to any changes thar suggest a need to modify the plan ofeare “The agency in cooperation with che physician, muse review the padent’s plan of cate as changes in con icon aces, bur areas every 60 days, This review gonealy occurs at che tne of ecetiication. The gency should have polices ther govern che reeriation proces. Seepage 4 «24 ‘Seaff mus slere the physician co changes that suggest «need to modify the pan ‘The nar ld coca he plc to review the plan of care whe the patie derlaps presare ale onthe butch pation om enteral rin let pounds the vo toes, ‘Conaliions of Parcicipation, §484.18(c): Verbal orders are put in writing and signed and dated ‘with he date of eceipt by the registered mare or qualified therapst responsible for Furnish Jingo supervising the services. Verbal orders ar only acceped by pesonnl authorized ro do soby applicable Sete and Federal laws and seglacions as well the agencysinternal policies. Anyindividal authorize by cee or he stats pracce act, such aan LPN, cherapy asian or soca work ssant, may rece and document verbal order. Thar person should contact the supervising Fegatered ure or thera to evew the order before implemeaeation. The registered use or quled therapist nuccalso ign the order and date ewich he dae of receipe (A quale sherapist or purposes, of veal oles ean bes physical therpis, a speech-language pathologist, an occupational thers, and a medical social worker) There tno eequeemene tha he arse o therapist mst sgn the order befoce he seaffmember provides he services. T minimize any survey difficucies, ndestand your sacs requltement for practice. Insite a sem for completion, evew by a repsered nus or qualified therapist and/or physician couneeignacureof order received by other auchoried personnel. Seepage Sols, ‘TieBcs of Medicare Sree Davey 135