Home Health & Hospice Articles by Topic: Policies and Procedures

What's an example of a billing aberrancy that's prompting contractors to target agencies in targeted probe-and-educate reviews?

• Homecare Q&A, Issue 12, July 25, 2018

  We see inappropriate recertifications all over the place.

Looking for some guidance on a patient with a closed stage IV pressure ulcer who now presents with non-blanchable redness to the same injury site but skin is intact.

• Homecare Q&A, Issue 12, July 25, 2018

  Once the wound is fully granulated and the wound surface is covered with epithelial tissue, the...

How should I act in the following scenario involving power of attorney (POA)?

• Homecare Q&A, Issue 12, July 25, 2018

  First determine if the POA is medical and if the patient is incapacitated.

Can advanced practice nurses (APNs) sign orders for home health patients?

• Homecare Q&A, Issue 12, July 25, 2018

  APRAs cannot write orders for a plan of care or subsequent verbal orders.

If a patient requires assistance to complete ADLs but is independent with all gait and mobility, can the person still be considered homebound per Medicare guidelines due to the taxing effort of getting ready to leave the home?

• Homecare Q&A, Issue 11, July 15, 2018

  This question cannot be answered, as each eligibility is established with each particular patient.

We have a policy that the patient must sign the tablet (EMR) post-visit. If a patient lives in an ALF and has dementia, is it OK to ask the patient to sign?

• Homecare Q&A, Issue 11, July 15, 2018

  There is no CMS regulation to have the EMR/tablet/daily visit record signed.

What if the PT and OT are ordered at SOC and the PT does an evaluation and no further treatments are ordered/planned but the OT does an eval and stays in alone for the episode?

• Homecare Q&A, Issue 11, July 15, 2018

  Per §1814(a)(2)(C) and §1835(a)(2)(A) of the Social Security Act, the patient must be in...

Our agency has had difficulty getting documentation for the F2F requirement from certain physicians. Should we deny the referrals?

• Homecare Q&A, Issue 11, July 15, 2018

  Denying a referral should be a determination based on agency policy and physician...

Review your emergency preparedness - it's a top target on surveys in 2018

• Homecare Direction, Issue 7, July 2, 2018

  Among the top 12 standard-level deficiencies in home health thus far in 2018, seven involve issues...

Is it OK to accept a doctor's signature on one page of a multi-page order as being signed?

• Homecare Q&A, Issue 10, June 11, 2018

  It is important for the pages of the plan of care to be clearly numbered if there is more than one...

Is it necessary to document the RVVO piece of a verbal order?

• Homecare Q&A, Issue 10, June 11, 2018

  The Joint Commission (TJC) includes a requirement under the Provision of Care, Treatment and...

Can we send an LPN to have consents signed and do wound care at SOC if the RN can’t come timely?

• Homecare Q&A, Issue 10, June 11, 2018

  PNs - along with occupational and physical therapy assistants - aren't qualified to establish the...

Say an agency is starting from scratch on the process of responding to ADRs. What is the first thing that should be put in place?

• Homecare Q&A, Issue 9, May 12, 2018

  First off, know on the front end that the biller is looking for those requested records. Ensure...

Do we need to enumerate one by one the patient?s rights over the phone to the legal representative?

• Homecare Q&A, Issue 9, May 12, 2018

  This can be done by electronic methods.

Do agencies have the right to tell patients we require a written request for patient records if the patient asks for a record over the phone?

• Homecare Q&A, Issue 9, May 12, 2018

  Agencies may require patients to make a written request for copies of the medical record. This is a...

For hospice, can activity done over the phone with a patient by a chaplain or social worker be considered a visit if the call is extensive and covers several items from the plan of care (POC)? What about for the purposes of meeting HIS quality measures?

• Homecare Q&A, Issue 8, April 17, 2018

  No conversation on the phone can be billable, as is the same for HIS quality measures.

How do we count the 14-day certified home health aide supervisory visit? Is the day of the visit day 1 or is the day after the visit day 1?

• Homecare Q&A, Issue 8, April 17, 2018

  The supervisory visits need to be no less frequently than every 14 days from the date of the first...

Train intake to gather more detail, ensure patient rights process is efficient

• Homecare Direction, Issue 4, April 12, 2018

  To help comply with the new patient rights requirements in the revised Home Health Conditions of...

Consider these 9 ways to avoid the hazards of an OSHA investigation

• Homecare Direction, Issue 3, March 26, 2018

  The lack of an appointed head of the Occupational Safe-ty and Health Administration (OSHA) has...

Improve on medication management in your performance improvement project

• Homecare Direction, Issue 3, March 12, 2018

  Agencies gearing up for the performance improvement project (PIP) requirement under the revised...

What data do we need to collect for QAPI?

• Homecare Q&A, Issue 2, January 17, 2018

  After defining the scope of an agency’s QAPI program, the CoPs outline how the quality...

Our agency looks at the PEPPER reports, but what pieces of information are most important?

• Homecare Q&A, Issue 2, January 17, 2018

  Note PEPPER’s six target areas: Average case mix. This target area calculates average case...

Prepare for new CoPs: Draft interpretive guidelines for the CoPs answer some questions, create others

• Homecare Direction, Issue 12, December 11, 2017

  CMS’ long-awaited draft version of the interpretive guidelines for the revised Home Health...

We are creating CDI policies. What should we include?

• Homecare Q&A, Issue 22, November 17, 2017

  The CDI department should have its own set of policies and procedures to govern its...

New low-volume option could shrink the line of appeals at the ALJ level

• Homecare E-News, Issue 43, November 13, 2017

  Home health agencies and other providers with a low volume of pending appeals at the administrative...

What procedures are we required to have?

• Homecare Q&A, Issue 20, October 17, 2017

  Procedures are detailed descriptions of the tasks required to implement and maintain agency...

Do we need clinical staffing benchmarks?

• Homecare Q&A, Issue 20, October 17, 2017

  Agencies must identify not only the appropriate compensation for staff but also the...

How can we use electronic clinical pathways to improve outcomes?

• Homecare Q&A, Issue 20, October 17, 2017

  Consider adopting clinical pathways to increase nursing visit efficiency, decrease...

Where is it specifically written that an NP or a PA cannot sign homecare orders?

• Homecare Q&A, Issue 20, October 17, 2017

  There is no language specifically stating an NP or PA cannot give orders. Rather, the rules...

What kind of personnel policies should we have?

• Homecare Q&A, Issue 18, September 19, 2017

   Some example of areas that an agency’s personnel policies should address are:

What should we do to better handle Additional Development Requests (ADR)?

• Homecare Q&A, Issue 18, September 19, 2017

  Here’s how to improve on ADRs:

Tip: Follow policy on staff discipline and discharge

• Homecare E-News, Issue 35, September 18, 2017

  The agency’s policies and procedures will include a discipline and discharge policy. It is...

What should our agency be aware of during hurricane season?

• Homecare Q&A, Issue 18, September 17, 2017

  Excellent question, given the active season we’ve been having. You must comply with...

Staff trainer quiz

• Homecare Direction, Issue 8, August 25, 2017

  1. Why is it important to practice infection control?

Staff trainer: Stop the spread

• Homecare Direction, Issue 8, August 25, 2017

  As an HHA staffer or nurse, you care for people in vital ways—bathing, grooming, feeding...

What does a psychosocial assessment need to include?

• Homecare Q&A, Issue 14, July 17, 2017

   The CoPs make clear that the plan of care will continue to be based on the comprehensive...

When we enter our discharge reason for home health, is it that the patient was transferred to an inpatient facility, or is the discharge reason that the patient expired?

• Homecare Q&A, Issue 16, August 22, 2016

  When our patients are admitted to an inpatient facility and we complete a transfer OASIS, we...

What advice do you have regarding policies in homecare agencies? We are reviewing ours and aren't sure if we should have more or less.

• Homecare Q&A, Issue 11, June 3, 2016

  First and foremost, a policy and a procedure are two entirely different animals. A policy is...

Discharge or hold for holiday vacation?

• Homecare Q&A, Issue 2, January 18, 2016

  We have a patient that meets Medicare eligibility for home health services, remains homebound, and...

Inside Story | Cerebrovascular disease (stroke) care

• Homecare E-News, Issue 2, January 11, 2016

  When working with stroke patients, you are responsible for several types of observations. First...

How can we document to support supply utilization and payment?

• Homecare Q&A, Issue 23, December 4, 2015

  Documentation will be important to support supply utilization and payment. Claims must include...

What content would be in a best practice statement for homecare providers?

• Homecare Q&A, Issue 23, December 4, 2015

  Best practice should identify clinical actions—assessment, teaching, procedures...

What policies do we need, and which additional policies should we have?

• Homecare Q&A, Issue 22, November 17, 2015

  What policies do we need, and which additional policies should we have?

Is there a guideline regarding the frequency of visits for psychiatric patients?

• Homecare Q&A, Issue 21, November 3, 2015

  Establishing a frequency is considered very unique, as a psychiatric patient sometimes requires the...

The Inside Story | Staff education on infection control

• Homecare E-News, Issue 40, October 19, 2015

  Care delivered according to infection control guidelines is the most effective tool available for...

In focus | NAHC submits comments on face-to-face clinical templates

• Homecare E-News, Issue 41, October 19, 2015

  Last Tuesday, NAHC submitted official comments to CMS on a pair of proposed clinical templates (one...

What are some approaches patients may try to implement themselves to overcome swallowing difficulties, and what are more effective alternatives?

• Homecare Q&A, Issue 20, October 16, 2015

  What are some approaches patients may try to implement themselves to overcome swallowing...

In focus | NAHC summarizes latest developments on the face-to-face reform front

• Homecare E-News, Issue 40, October 12, 2015

  While awaiting an imminent decision in its lawsuit challenging the validity of the physician...

Do regulations mandate any particular form or format for documentation or confirmation of verbal orders?

• Homecare Q&A, Issue 17, September 8, 2015

  No. The regulations do not mandate any particular form or format for documentation or confirmation...

How are we supposed to use observation and assessment for patients on telemonitoring?

• Homecare Q&A, Issue 15, August 3, 2015

  Telemonitoring or telehealth is one technology that can help a patient in the home. It cannot...

What content would be in a best practice statement for homecare providers?

• Homecare Q&A, Issue 13, July 2, 2015

  AA best practice should identify clinical actions—assessment, teaching, procedures...

Should there be one signature per order, or can orders be batch signed?

• Homecare Q&A, Issue 13, July 2, 2015

  As long as the order is a complete order for a treatment or therapy, you may have more than one...

Homecare Q&A

• Homecare Q&A, Issue 13, July 2, 2015

  July 3, 2015

Can we use standing orders for many of our specialty programs, like wound care?

• Homecare Q&A, Issue 11, June 3, 2015

  Can we use standing orders for many of our specialty programs, like wound care?

Can we accept orders from a physician?s secretary or office nurse who is communicating with us instead of the physician?

• Homecare Q&A, Issue 11, June 3, 2015

  Can we accept orders from a physician’s secretary or office nurse who is communicating with...

What should you do about a tardy recertification assessment?

• Homecare Q&A, Issue 10, May 17, 2015

  What should you do about a tardy recertification assessment?

Any tips for preventing future legal fallout in such cases?

• Homecare Q&A, Issue 7, April 3, 2015

  Unfortunately, when a fall occurs in the presence of agency staff, people assume that it...

How do I ensure each care team is led appropriately by the case manager?

• Homecare Q&A, Issue 6, March 17, 2015

  Effective teams need leadership. By using the term “case manager,” the home health...

How do you encourage reporting and open communication?

• Homecare Q&A, Issue 6, March 17, 2015

  What you are looking for is a nonpunitive, “just” culture for your agency, or a...

How can I ensure more effective meetings at our agency?

• Homecare Q&A, Issue 5, March 3, 2015

  We spend a tremendous amount of time in meetings. Many of them are boring, nonproductive, and...

Is there a requirement to have our annual program review/PAC minutes approved by our board of directors each year?

• Homecare Q&A, Issue 5, March 3, 2015

  There is not a specific Condition of Participation (CoP) stating that the board must review your...

Will home health remain exempt from overtime compensation in most circumstances like it has for 40 years?

• Homecare Insider, Issue 1, January 5, 2015

  Will home health remain exempt from overtime compensation in most circumstances like it has for 40...