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Simplify Documentation of Missed Visits

Homecare Insider, October 19, 2009

The documentation of missed visits is one of those perplexing issues that homecare providers confront.  Look at these sample questions.

What is the necessary paperwork to complete if the nurse omits a visit because the patient has a physician's appointment on the same day?  
How do we document that the patient canceled a visit by a home health aide?

Let’s quickly review the facts about missed visits.

  • A missed visit modifies the frequency of visits the physician ordered.  If the agency can reschedule the visit during the same week, thereby maintaining the physician-ordered frequency of visits, there is no missed visit.
  • There is no requirement that the agency must obtain a physician’s order to cover the missed visit.
  • The agency must notify the physician about the missed visit.  Reason:  The Conditions of Participation require staff to notify the physician about changes that suggest a need to modify the plan of care.  
  • The agency decides how it wants to document missed visits.

An agency can choose to use a missed visit report.  Advantages:  The report includes prompts to ensure complete and concise documentation of information.  The agency can fax the report to the physician’s office or use it as the basis for reporting information during a telephone call.

However, there are options to using a report.  The simplest:  Document all pertinent details in a communication or visit note, including:

  • the patient’s name
  • the date and type of visit
  • a reason why the visit was missed
  • impact of the missed visit upon the patient or how the patient’s needs were met (A missed visit should not put the patient in jeopardy.)
  • physician notification (date, time, physician name, method of notification, staff member)
  • signature of staff member reporting the information.

File documentation about the missed visit in the patient’s clinical record.  

The Beacon Guide to Medicare Service Delivery, now in its ninth edition, is an essential reference to help you streamline agency operations.  Check out this valuable resource.