Ch 38: Home Nutrition Support Flashcards
Most insurance companies require home nutrition support to be what?
Medically necessary and the sole source of nutrition
Government payers and insurers who follow the Medicare coverage criteria may require substantiation of needed over time
EN and PN are primarily covered under which benefit under Medicare part B program?
Prosthetic device benefit
This provision requires a permanent dysfunction of a body organ. Medicare requires therapy to be reasonable and necessary for diagnosis or treatment of illness or injury to improve the functioning of a malformed body part
In Medicare terms, how long is a permanent condition?
At least 3 months
Per Medicare, what type of formula is considered appropriate for most patients requiring HEN?
Standard polymetric
Additional documentation needed for specialty produces. Clinicians should be aware that not all formulas w/in Medicare coverage category are clinically equivalent or interchangeable, though they may be reimbursed at the same rate
What are the suggested lab panels that should be monitored with home PN?
Suggested lab panels to evaluate include BMP, hepatic function panel, plasma proteins, complete bood count mg, and phos
How often should labs be checked for home PN patients?
Initially, labs should be done one/week for 4 weeks or until values are stable. Once stable, lab monitoring may be shifted to once/month
Trace elements, vitamins, and phospholipid FA profile should be checked every 3-12 months with more frequent monitoring for patients with know deficiencies, or toxicities or when national shortages of IV trace elements, vitamin, or lipids occur
• Soybean oil-based ILE should provide less than____ g fat per kg body weight per day
less than 1 g fat per kg body weight per day
For home PN patients, how often should bone mineral testing be done?
Bone mineral testing should be done annually
PN patients should be monitored for iron deficiency b/c iron not routinely added to PN; serum trace should be monitored every 3-12 months to prevent deficiency and toxicity
Which agency accredits home care companies?
The Joint Commission
Following initial certification of parenteral nutrition by Medicare, after what length of time is recertification required?
6 months
After initial certification for parenteral nutrition is obtained, recertification is required after 6 months of therapy. The recertification process is used to document the patient’s continued need for therapy; additional recertifications may be requested on an individual basis.
What conditions must be met for a patient to qualify as a beneficiary for home EN under Medicare Part B?
Home enteral nutrition is a covered Medicare Part B benefit for a patient who has a permanent condition or disorder (>90 days) that impairs food from reaching the small bowel or disease of the small bowel that impairs digestion and absorption of adequate nutrition.
The beneficiary must require tube feeding to provide adequate nutrients to maintain weight and strength to align with their overall health status. The patient’s condition could be either anatomic, e.g. obstruction due to head and neck cancer or reconstructive surgery, or due to a motility disorder, e.g. severe dysphagia following a stroke. Enteral nutrition is not covered for patients with a functioning gastrointestinal tract whose need for enteral nutrition is due to reasons such as anorexia, malnutrition, or nausea.
Medicare reimbursement for home and community-based professional nutrition education services provided by a registered dietitian is restricted to patients who have which diagnosis/situations?
Diabetes, pre-dialysis kidney disease, and those who previously had a kidney transplant.
Managed care and private insurance companies often use which established criteria/guidelines when approving coverage for home parenteral nutrition (HPN)?
Medicare criteria
Patient education materials for home enteral and parenteral nutrition patients should be written at what grade level?
5th or 6th
The maximum hang time an open system enteral feeding formulation container in the home setting is home long?
12 hours
Open system enteral feeding containers should have a hang time of no more than 12 hrs at home and 8 hrs in the hospital. Open system enteral feeding containers are more likely to be exposed to contaminants
Initially, how often should electrolytes be monitored in a patient on home parenteral nutrition support?
Weekly; A.S.P.E.N. recommends weekly monitoring of serum glucose, electrolytes, blood urea nitrogen, creatinine, magnesium and phosphorus for four weeks or until the patient is clinically stable
Which types of vascular access devices are approved for home PN administration?
Tunneled central venous catheters, implanted ports, peripherally inserted central catheters.
According to the Centers for Medicare and Medicaid Services, which criteria should be met as an indication for home parenteral nutrition?
Documented evidence of inability to tolerate feeding through the enteral route.
Typically, HPN is covered for patients with less than or equal to 5 feet of small bowel beyond the ligament of Treitz; gastrointestinal losses exceeding 50% of oral intake (2.5 to 3 liters per day in and > 1.25 to 1.5 L/day out). Bowel rest is required for at least 90 days and 20-35 calories per kilogram (kg) per day is prescribed.
Third-party payors (insurance companies) are LEAST likely to reimburse which of the following home enteral nutrition expenses?
Enteral formula
Many third-party payors equate the costs of enteral formulas to “ groceries” and do not cover this expense, while they will cover the costs of an enteral pump and supplies.
Formula is covered under Medicare Part B, but the patient will be financially responsible for 20% of the Medicare approved amount. If the patient has a supplement or secondary insurance, it will usually pick up the 20% that Medicare does not cover.
To meet the Medicare payor criteria for home enteral or parenteral nutrition, the patient’s condition must be considered to be “of long and indefinite duration”. Which length of time meets Medicare’s test of permanence requirement?
> 90 days
Home-prepared or blenderized enteral nutrition (EN) formulations should be discarded after how long?
24 hours; The use of home-prepared or blenderized EN formulations requires additional attention to nutrient content and safe food handling and storage practices. These formulas should be discarded after 24 hours. Hang time for blenderized or reconstituted formula is 4 hrs.
All patients on PN greater than one year should be screened for what?
Metabolic bone disease; Bone mineral testing (DEXA) should be done annually.
Which conditions increase the risk of aluminum toxicity in patients on long term PN?
Renal failure and iron deficiency anemia
A 70% ethanol lock (ELT) solution removes what inside a VAD?
Luminal biofilm in which microorganisms are harbored
ELT increases breakage and thrombosis and weakens VADs made from polyurethane. Ethanol is incompatible with heparin.
