Home Health Lecture Flashcards
What is the name of the document used for Medicare reimbursement in the Home Health setting?
OASIS
When is the OASIS information collected? (4)
- Start of care
- 60 day follow up
- discharge
- surrounding an inpatient facility stay
In Home Health setting a _ _ is paid to the agency based on the _ _ using a Home Health Related Group (HHRG).
In the HH setting a SET AMOUNT is paid to the agency based on the OASIS ASSESSMENT using a HHRG.
_ _ can increase payment in a HH setting. _/ _ _ can decrease payment. _ is key to reimbursement.
THERAPY MODIFIERS can increase payment
ADC/ RAC AUDITS can decrease payment.
DOCUMENTATION is key to reimbursement.
The OASIS assessment must be _ in _ by _ _ _ _. It _ _ _ if all aspect of assessment fall within your _ of _.
Must be COMPLETED IN FULL by WHOMEVER PERFORMS INITIAL VISIT.
It DOES NOT MATTER if all aspects of the assessment fall within your SCOPE OF PRACTICE.
OASIS document includes: patient , _ and hospitalization information, evaluation of , _, _, elimination ( and ), _// assessment, _/ _, and medication and case _.
Includes: patient DEMOGRAPHICS, DIAGNOSIS and hospitalization information, evaluation of SENSORY, INTEGUMENTARY, RESPIRATORY, elimination (BOWEL and BLADDER), ADL’S/ IADL’S, NEURO/EMOTIONAL/ BEHAVIORAL assessment, and medication and case MANAGMENT.
How is each activity scored?
On a 0-6 scale, similar to FIM score
The _ _ _ _ _ (_) tracks progress with bathing, gait, toileting, medical management, transfers, dyspnea. In order to be reimbursed you need to show _ of _ _ _ _ on OASIS scale in _ _.
The MEDICARE OUTCOMES BASED QUALITY INITIATIVE (OBQI) tracks progress with bathing, gait, toileting, medical management, transfers and dyspnea.
In order to be reimbursed you need to show IMPROVEMENT of AT LEAST ONE NUMBER on OASIS scale in EACH AREA.
_ _ _ _ _ (_) identifies key areas of assessment to plan frequency and appropriate disciplines.
SERVICE UTILIZATION REVIEW OF CARE in the HOME (SURCH)
In order to maintain eligibility for HH services patient must have _ _ for _ and be _. _ _ does not consider availability or access transportation. Patient must be _ _ to _ the _.
In order to maintain eligibility for HH services must have SKILLED NEED for SERVICES and be HOMEBOUND.
HOMEBOUND CRITERIA does not consider availability or access to transportation.
Patient must be PHYSICALLY UNABLE to LEAVE the HOUSE.
Homebound status must be _ on _ _. 3 exceptions?
Homebound status must be DOCUMENTED on EACH VISIT
3 exceptions (MCH)
- MD visits/ dialysis
- Church
- hair appointments
3 reasons for loss of homebound status: unable to _, _ _ due to not _ _, or patient _ _.
3 reasons for loss of homebound status: unable to JUSTIFY, MISSED VISITS due to patient not BEING HOME, or patient STARTS DRIVING.
Home Health Eligibility: prove that patient _ _ _; document _, _, and _ goals; make and document _, and if no progress is made _ _.
Prove that patient NEEDS SKILLED CARE; document MEASURABLE, OBTAINABLE, and OBJECTIVE goals; and if no progress is made DISCHARGE PATIENT.
PT oversight of PTA in HH setting: there is _ _ _ for communication, but need to be in contact to follow up on: _ of _, _, and any _ that need to be _.
There is NO SPECIFIC REQUIREMENT for communication, but need to be in contact to follow up on: PLAN OF CARE, PROGRESS, and any CHANGES that need to be MADE.
Medicare does not regulate visit _. General guidelines include: - visits _ _ for - weeks, with visits often being - then _- _.
Medicare does not regulate visit FREQUENCY
General guidelines include: 2-3 visits PER WEEK, for 2-4 weeks, with visit is often being FRONT-LOADED then TAPERED-OFF.
