Home Health & Hospice

Home Health & Hospice Articles by Topic: Documentation

We are a hospice. What should our response process be to an ADR?

  • Homecare Q&A, Issue 15, August 3, 2017

    When a hospice discovers a new ADR, staff should review the time frame for the ADR, assemble...

What constitutes medical necessity when it comes to psychiatric care?

  • Homecare Q&A, Issue 15, August 3, 2017

    The proof of medical necessity strictly relies on the MD documentation and diagnosis and the...

How can we prepare for the pre-claim demo?

  • Homecare Q&A, Issue 5, August 3, 2017

    Become more proactive. You no longer can wait for face-to-face documentation to arrive within...

How can our agency get started on implementinga clinical documentation improvement (CDI) program? We already have a CDI specialist/committee to lead the effort. How can we rally in external sources of better documentation?

  • Homecare Q&A, Issue 15, August 3, 2017

    The first decision for the CDI committee is to establish which CDI program model to adopt. The...

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...

How can we improve on timely initiation of care?

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

    As part of a monthly or quarterly quality assurance review, agencies should closely monitor...

Changes to make with new Medicare cards

  • Homecare E-News, Issue 27, July 17, 2017

    The Medicare Access and CHIP Reauthorization Act of 2015 requires CMS to remove social security...

Weekly Roundup

  • Homecare E-News, Issue 40, October 24, 2016

    New communication ruling for home health and hospices takes effect. This week, the Centers...

Can you please review what is needed for documentation (in terms of payment) for the plan of care?

  • Homecare Q&A, Issue 18, September 17, 2016

    Patients of the Medicare-certified agency who are under the care of a physician and receiving home...

I have a question regarding how to write frequencies for services when the discipline only does the evaluation visit and no other visits that week.

  • Homecare Q&A, Issue 18, September 17, 2016

    Thank you for your question and your commitment to compliance.  Per the CMS Survey Manual...

What does the summary report on the clinical record need to entail?

  • Homecare Q&A, Issue 14, July 17, 2016

    The Conditions of Participation (CoP) mandate the agency to send a summary report to the physician...

What can the physician write for duration of care with patients who open and close with leg ulcers?

  • Homecare Q&A, Issue 14, July 17, 2016

    According to the National Association for Homecare & Hospice (NAHC):

How should our documentation system for patient care plans work?

  • Homecare Q&A, Issue 13, July 3, 2016

    The patient care plan (485) is not a stand-alone documentation system; it is the legal record of...

What tips do you have for therapy assistants in terms of clinical documentation?

  • Homecare Q&A, Issue 10, May 17, 2016

     As is true for the qualified therapist, the amount of information and regulation that the...

Can a discharge planner pull information from a patient's record and document the clinical findings for the need for each discipline and homebound clinical findings?

  • Homecare Q&A, Issue 10, May 17, 2016

    As a representative of the physician, the discharge planner could gather all information. As long...

What is the best way to comply with the new Medicare regulation that took effect on August 11, 2015, which is the recertification attestation by MDs?

  • Homecare Q&A, Issue 8, April 17, 2016

    What is the best way to comply with the new Medicare regulation that took effect on August 11...

Is an "MDD" classification sufficient for coding a homecare patient?s depression?

  • Homecare Q&A, Issue 7, April 4, 2016

    No. ICD-10-CM classifies depression under Disorder, depressive, major (MDD), but more information...

What is the best approach to a summary report?

  • Homecare Q&A, Issue 7, April 4, 2016

    The Conditions of Participation (CoP) mandate the agency to send a summary report to the physician...

When should we conduct chart audits?

  • Homecare Q&A, Issue 7, April 4, 2016

    You can never conduct too many chart audits. However, there are certain time points when you...

What are some standardized approaches to care planning?

  • Homecare Q&A, Issue 7, April 4, 2016

    Although it plays an important role in care planning, delivery, and coordination, the care plan...

Question on physician signatures

  • Homecare Q&A, Issue 6, March 18, 2016

    We have been getting complaints from physicians regarding too much paperwork that we send to them...

What are some plan of care pitfalls to avoid?

  • Homecare Q&A, Issue 4, February 18, 2016

    What are some plan of care pitfalls to avoid?

Weekly roundup

  • Homecare E-News, Issue 7, February 15, 2016

    CMS intends to start a Medicare Probable Fraud Measurement Pilot for home healthcare services...

Can the OASIS then be updated (by the assessing clinician) within the five-day window, using information gathered from that collaboration, if the M0090 date is also updated?

  • Homecare Q&A, Issue 3, February 3, 2016

    Thank you for your question and commitment to compliance. You are correct that the assessment must...

May we accept orders for labs from a physician assistant (PA) who is listed on the 485?

  • Homecare Q&A, Issue 3, February 3, 2016

    Thank you for your question and your commitment to compliance. According to the Medicare Benefit...

Which assessments should the nurse do when the patient receiving only personal care services now needs and qualifies for Medicare coverage? What about when the patient switches from Medicare to Medicaid?

  • Homecare Q&A, Issue 24, December 17, 2015

    The first step in answering these questions is to know the requirements for data collection and...

Are clerical staff able to enter written orders from the MD into the electronic medical record if the RN verifies the entry in both Michigan and Wisconsin?

  • Homecare Q&A, Issue 24, December 17, 2015

    It is not prohibited but will require tight controls in place. Please review practice brief about...

Do we need to do a Transfer and Resumption of Care for a patient that was in the hospital for observation longer than 24 hours but not as an inpatient?

  • Homecare Q&A, Issue 24, December 17, 2015

    The following is a clarification by CMS regarding this subject:

In Focus | Improper payments remain an issue

  • Homecare E-News, Issue 47, November 30, 2015

    The U.S. Department of Health and Human Services released its Agency Financial Report for fiscal...

Can we accept physician verbal orders to begin home health services?

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

    We are seeking clarification on whether we can accept a physician’s verbal order to begin...

Do we need documentation regarding the legitmacy of a discharge planner?

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

    Our agency is asking for clarification of whether an agency relationship exists between hospital...

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...

We are in disagreement about whether that is an appropriate frequency.

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

    We are in disagreement about whether that is an appropriate frequency.  

What kind of events count as "potentially avoidable"? What will and should be in the CASPER Outcome-Based Quality Improvement Report?

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

    What kind of events count as "potentially avoidable"? What will and should be in the...

Is it true that the following documentation is an improper certification statement on our home health agency's plan of care?

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

    Is it true that the following documentation is an improper certification statement on our home...

I have a question regarding the face-to-face requirements for homecare.

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

    I have a question regarding the face-to-face requirements for homecare...

The Inside Story | Start-of-Care and Resumption-of-Care Assessments

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

    The start-of-care (SOC) assessment is completed as a patient is being admitted to a home health...

We are having an issue with noncoverage for therapy. What are the rules for therapy services to be covered? Could you explain and expand, providing some examples?

  • Homecare Q&A, Issue 19, October 2, 2015

    We are having an issue with noncoverage for therapy. What are the rules for therapy services to be...

We have been told that the following documentation would position us for a potential claim denial. Can you help explain?

  • Homecare Q&A, Issue 19, October 2, 2015

    We have been told that the following documentation would position us for a potential claim denial...

How do we update the comprehensive assessment for a major deterioration in status with the PPS payment requirements?

  • Homecare Q&A, Issue 18, September 17, 2015

     This patient’s change in condition has a real impact on resource utilization—an...

What does a comprehensive assessment include for non-OASIS patients, according to the Conditions of Participation (CoP)?

  • Homecare Q&A, Issue 18, September 17, 2015

    The CoPs identify several key components for this assessment. Here are the components and some...

What should be our frequency of visits?

  • Homecare Q&A, Issue 18, September 17, 2015

     We have an 87-year-old woman who was referred by the wound care center for care of a wound...

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...

We discharged a patient who then resumed services. Are we going to have troubles receiving reimbursement?

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

    If an agency discharges a patient and that patient resumes services, there may be questions about...

If the patient does not require a skilled bath, can our agency continue to provide this under the state personal care program?

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

    Medicare doesn’t differentiate between skilled and unskilled personal care because there...

If the patient has an ostomy, cannot change it, and there are no caregivers to learn, does the agency stay in indefinitely?

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

    Changing an ostomy bag, even if the patient can’t do it and there’s no caregiver...

When does Medicare consider a wound as chronic/nonhealing and no longer pays for services?

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

    You won’t find any mention in the Medicare coverage criteria about chronic or nonhealing...

Is it an appropriate use of Medicare to do three weeks of assessment and venipuncture for a patient hospitalized with DVT?

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

    Since 1997, venipuncture has not been a qualifying service for Medicare coverage. However, once the...

Is it permissible for a hospital discharge planner to make an entry into a patient hospital record and have the physician sign the entry (to support home health eligibility)?

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

    Is it permissible for a hospital discharge planner to make an entry into a patient hospital record...

How to score an incomplete OASIS?

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

    I am specifically looking for the guidance indicating that, when an OASIS assessment is not...

If there are verbal orders at start of care, do we need to use Locator 23?

  • Homecare Q&A, Issue 14, July 16, 2015

    This locator applies only if verbal orders are involved in the start of care process. It...

Is it true that we must receive the signed plan of care and all verbal orders prior to submitting the claim?

  • Homecare Q&A, Issue 14, July 16, 2015

    Yes, it’s true. You can find that requirement in CMS Publication 100-2, Chapter...

I have read that CMS in 2015 has added to the Medicare manual that physicians need to estimate how much longer the skilled services will be required. Is there any clarification on this, and are we seeing any claims being denied due to this?

  • Homecare Q&A, Issue 14, July 16, 2015

    According to the final rule for 2015, physicians must state the length of skilled services for...

Can physical therapy go out and have consents signed and perform an evaluation before the nurse gets to the home to complete the OASIS as long as it is all done the same day?

  • Homecare Q&A, Issue 14, July 16, 2015

    The only similar guidance found was according to CMS’ OASIS Q&A:

I am wondering how to answer OASIS assessment "M" items when an OASIS assessment is needed for a payer change, but one does not exist.

  • Homecare Q&A, Issue 14, July 16, 2015

    Thanks for your question and commitment to compliance. In cases where you learn after the fact...

How do we get paid when we have two different payers?traditional Medicare (Part A) and MA?within the same 60-day episode?

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

    If a patient switches from traditional Medicare to MA, the agency will receive a partial episode...

Would NA (not applicable) be the correct response to M0110 and M2200 for MA patients?

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

    AM0110, Episode Timing, and M2200, Therapy Need, apply when the assessment will determine the...

We continue to have confusion over what is considered a ?nonroutine supply.? Can you help clarify?

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

    The coverage of nonroutine supplies is probably the most confusing component of the consolidated...

Will Medicare cover lymphedema therapy?

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

    Lymphedema therapy is an extensive treatment involving a combination of manual decongestive therapy...

Can physical therapy be considered the qualifying service to establish a need for ongoing occupational therapy?

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

    Occupational therapy cannot qualify a patient for coverage initially, but after the patient has had...

What can trigger an ABN, and what must be documented? What about an HHCCN?

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

    The ABN (CMS-R-131) is a written notice that the agency must provide to a PPS Medicare-eligible...

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

If an agency discharges a patient with goals met but then readmits him or her within 60 days of discharge, would the new episode be an early or later one for M0110, episode timing?

  • Homecare Q&A, Issue 12, June 15, 2015

    If an agency discharges a patient with goals met but then readmits him or her within 60 days of...

How do we determine diagnosis and priority?

  • Homecare Q&A, Issue 12, June 15, 2015

    Q: We are seeing a patient with Alzheimer’s disease, who was hospitalized for advanced...

What about goals, rehabilitation potential, and discharge plans? What are some key points we need to keep in mind while entering those into the 485?

  • Homecare Q&A, Issue 12, June 15, 2015

    What about goals, rehabilitation potential, and discharge plans? What are some key points we need...

What is the proper way to enter in orders for disciplines and treatments on the 485?

  • Homecare Q&A, Issue 12, June 15, 2015

    What is the proper way to enter in orders for disciplines and treatments on the 485?

Where can I find that it would be illegal to charge a Medicare home health patient prior to rendering services, while reimbursing patient once CMS has paid the claim?

  • Homecare Q&A, Issue 12, June 15, 2015

    Assignment of benefits - This term means that the facility or the physician agrees to accept...

What does Patient Care 484.60: Care Planning, Coordination of Services and Quality of Care mean for agencies?

  • Homecare Q&A, Issue 8, June 9, 2015

     First, let’s review for everyone reading what the current CoP is and what is being...

What are some tips when evaluating our documentation system?

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

     What are some tips when evaluating our documentation system?

Are other agencies billing for the final skilled visit when the discharge reason is no longer homebound?

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

     A clinician arrives at the home, where skilled services are provided. Based on the...

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

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

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

How can extended daily visits be justified and covered?

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

    How can extended daily visits be justified and covered?

Where can I find the rule about physician cosigning of a nurse practitioner's order so the order is valid?

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

    Where can I find the rule about physician cosigning of a nurse practitioner’s order so the...

Can you shed some light on specific circumstances that warrant the resumption of care assessment?

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

    The ROC assessment is completed any time a patient has returned home following an inpatient stay of...

Where in the CMS guidelines does it indicate that there should be short-term and longterm goals for therapy?

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

    Palmetto and CGS have specific local coverage determinations (LCD) regarding shortand long-term...

Does the start of the VFOs for the HCA need to begin on the day of the new cert period, or can it begin the following week?

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

    You can write orders for when the services begin.

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 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...

Is a patient who is toileted every two hours covered under Medicare?

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

    In combination, the nurse and HHA can provide up to 35 hours a week in medically necessary...

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...