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Homebound Documentation

Last week, I wrote about homebound status and I am assuming that all my readers have mastered the nuances of homebound status (even though I am still on the fence about some). But knowing your patient is homebound isn’t enough to warrant payment from Medicare and other payor sources that insist your patients be homebound. You must document it.

Bad Documentation Good Documentation
Patient SOB with exertion (Hint: even triathletes get short winded in their fifth hour.) Patient is unable to walk greater than twenty feet without rest period
Patient requires assist devices to leave home. (Does my car count as assist device?) Patient unable to ambulate without walker and requires assistance to place walker in daughters car. Cannot use public transportation.
Leaving home medically contraindicated. Patient at great risk for infection due to compromised immune system secondary to chemotherapy.
Patient unsafe to leave home due to psychiatric reasons. Patient has history of wandering into oncoming traffic. OR, patient oriented times 2.
Patient unable to drive. Physically unable to drive due to arthritis pain in hands.
Homebound due to pain in joints Patient cannot stand for greater than ten minutes due to pain in hips/knees.
Homebound due to no car Can’t help you there
Homebound due to wounds Wounds to lower extremities at great risk for infection when patient leaves home.

Reading carefully, skillful documentation of homebound status is generally speaking much longer than a simple statement. While the statements in the ‘bad’ column may actually state the homebound reason, they do not offer enough information for a third party reviewer to make an independent determination of homebound status.

As someone who reviews clinical records, I become very interested in homebound status when the following findings are evident on the clinical record:

  • Multiple missed visit reports
  • Any missed visit reports without explanation
  • A functional score of F1 or F2. If a patient can bathe, toilet, and dress themselves and require little or no assistance ambulating and transferring, why can’t they leave the house?
  • Multiple documented absences from the home regardless of where the patient went.

Again, if you look at the jobs of RACs, PSCs, and ZPICs, it is far easier to deny an entire clinical record because the patient isn’t homebound rather than read each and every note and determine if the skills are billable in the context of the patient record. If I were paid for each time homebound status was questionable, I wouldn’t be writing this blog. I would be retired and playing bingo somewhere.

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