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Above is a very basic quiz on home health documentation.  It focuses on the type of errors that will result in claims being denied.  Is there a greater insult to a nurse than telling him or her that they do not deserve to be paid after going above and beyond to care for their patients?

Don’t let this happen to you.  Click the ‘Start Quiz’ link and find out how well your documentation measures up.  And call us if your agency might benefit from training from Haydel Consulting Services.


3 Comments Post a comment
  1. Susan J #

    Hi there. Please remember that not every RAC/MAC is going to sting you for therapy not having short and long term goals.

    I disagree with your response to #9 – the kind of wound is important to always be documented. origin, not so much, but is important potentially on new wounds, and OASIS for proper coding.

    and on #10, there may not be anything new to add to a care plan depending on what has exacerbated, and how often it does do so. My example would be an unstable HF patient on inotropics already and a comprehensive program may just be notifying the provider and following already established patient specific parameters on what to do if there is weight gain, etc.

    Just my opinion of course 🙂

    January 12, 2016

    • You are correct about therapy goals. Palmetto is the only MAC who positively insists on BOTH long and short term goals. CGS and NGS, not so much.

      The response to Number 9 was taken directly from the Medicare Benefits Manual. I agree with you. As someone who sees a lot more charts than patients, it drives me bonkers when I cannot find the source or kind of wound. I think it is worthwhile to share with everyone the section on wound care found in the manual.

      Care of wounds, (including, but not limited to, ulcers, burns, pressure sores, open surgical sites, fistulas, tube sites, and tumor erosion sites) when the skills of a licensed nurse are
      needed to provide safely and effectively the services necessary to treat the illness or injury, is considered to be a skilled nursing service. For skilled nursing care to be
      reasonable and necessary to treat a wound, the size, depth, nature of drainage (color,odor, consistency, and quantity), and condition and appearance of the skin surrounding the wound must be documented in the clinical findings so that an assessment of the need for skilled nursing care can be made. Coverage or denial of skilled nursing visits for wound care may not be based solely on the stage classification of the wound, but rather must be based on all of the documented clinical findings. Moreover, the plan of care must contain the specific instructions for the treatment of the wound. Where the physician has ordered appropriate active treatment (e.g., sterile or complex dressings, administration of prescription medications, etc.) of wounds with the following characteristics, the skills of a licensed nurse are usually reasonable and necessary:

      • Open wounds which are draining purulent or colored exudate or have a foul odor present or for which the patient is receiving antibiotic therapy;
      • Wounds with a drain or T-tube with requires shortening or movement of such drains;
      • Wounds which require irrigation or instillation of a sterile cleansing or medicated solution into several layers of tissue and skin and/or packing with sterile gauze;
      • Recently debrided ulcers;
      • Pressure sores (decubitus ulcers) with the following characteristics:
      o There is partial tissue loss with signs of infection such as foul odor or purulent drainage; or
      o There is full thickness tissue loss that involves exposure of fat or invasion of other tissue such as muscle or bone.

      NOTE: Wounds or ulcers that show redness, edema, and induration, at times with epidermal blistering or desquamation do not ordinarily require skilled nursing care.
      • Wounds with exposed internal vessels or a mass that may have a proclivity for hemorrhage when a dressing is changed (e.g., post radical neck surgery, cancer of the vulva);
      Open wounds or widespread skin complications following radiation therapy, or which result from immune deficiencies or vascular insufficiencies;
      • Post-operative wounds where there are complications such as infection or allergic reaction or where there is an underlying disease that has a reasonable potential to adversely affect healing (e.g., diabetes);
      • Third degree burns, and second degree burns where the size of the burn or presence of complications causes skilled nursing care to be needed;
      • Skin conditions that require application of nitrogen mustard or other chemotherapeutic medication that present a significant risk to the patient;
      • Other open or complex wounds that require treatment that can only be provided safely and effectively by a licensed nurse.

      My take on it is that while the origin and source of the wound are important for clinical care, Medicare coverage is determined by size, depth, nature of drainage (color,odor, consistency, and quantity), and condition and appearance of the skin surrounding the wound.

      Note that the question asks for that which should be charted on every note.

      You are also correct in noting that not every patient will be recertified due to an exacerbation. There are patients on inotropes as you suggested, other IV meds and those who need catheter changes who will not always have an exacerbation. Those are fairly infrequent but they exist. The question was not implying that exacerbations MUST be present. Rather, when a patient is recertified because a disease process exacerbated, it is important to understand what an exacerbation is. We frequently get denials that read something to the effect of, ‘There were no hospitalization, medication changes, new orders or changes to the plan of care’. The reviewers often go so far as to acknowledge that a blood pressure was high or the patient had continued pain BUT NO NEW ORDERS WERE RECEIVED.

      So there are patients who are not recertified due to an exacerbation but it is important to know how the reviewers are looking at exacerbations. Your opinion is always valuable. Never hesitate to call us out on what you feel may be incorrect or share with us an alternative view.

      January 12, 2016
  2. sahily #

    Awesome quiz! Thank you! —Failed to see “wound care orders” on Q9 !!!!

    January 12, 2016

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