Home Health & Hospice

Insider's Scoop | Determining and documenting the appropriate visit frequency

Homecare Insider, October 26, 2015

Editor’s note: This week’s Insider’s Scoop was adapted from one of HCPro’s newest home health titles, Documenting Medical Necessity: A Practical Guide for Home Healthwritten by Heather Calhoun, RN, BSN, HCS-D, COS-C. The complete manual provides down-to-earth, conversational documentation tips with dozens of example scenarios to help nurses understand medical necessity and document in a thorough manner that promotes the receipt of deserved reimbursement. For more information or to order, call customer service at 800-650-6787 or visit www.hcmarketplace.com

For years there has been debate on what is an appropriate frequency for a patient. Frequency depends on a number of factors, including:
  • Environment
  • Specific disease process
  • Complexity of the care that needs to be provided
  • Availability and knowledge of the patient and caregiver
The important thing to remember is that all patient frequencies need to be front-end loaded. This means that you want the majority of the visits to occur in the first four weeks of care. This does a number of things for the patient and/or caregiver. It provides a frequent watch on the patient to assess for any potential exacerbations that would warrant new care and change in the POC. It allows the clinician and the patient/caregiver to establish a rapport, which further assists with goal achievement. It provides the clinician with the ability to educate the patient and caregiver in those areas that will further facilitate recovery and ultimately return the patient to his or her prior level of function. Remember, the ultimate goal of the home health clinician is to keep the patient out of the hospital and improve his or her health.
HHAs sometimes provide care maps or paths to clinicians to help determine how many visits will be needed. These are small individual educational booklets on various diseases and/or self-care tasks that are common to HHAs. Often, these booklets have a guide on the first page to give the clinician an idea of how many visits will be needed in order to complete education on the booklet. The clinician still has to document the need for the education and continuation of need on each visit. These booklets are often left with the patient in the home folder and bits of information from the booklet are taught during each home health visit. This process allows the clinician to prevent repetitive teaching. It also provides some organized flow and prioritizes the information that is given to the patient.
If an agency utilizes as-needed clinicians or there is minimal continuity of care, then use of these care maps is a good way to stay on track and keep from duplicating education to the patient and/or caregiver. Any duplications of education provided to a patient during a visit would be considered nonbillable if the clinician documents that the patient and/or caregiver understood and verbalized the material presented during that visit. If a patient and/or caregiver does not understand the material that was taught, then Medicare will allow the clinician to reeducate on that same information during another visit.

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