Archive for 'Tool Kit'

Home Health Diagnosis Coding: Dehisced Wound Or Pressure Ulcer?

Posted on 03. Feb, 2010 by .

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Question: We have a patient who was admitted to service following a revision of a pedicle or flap graft (procedure code 86.75). At recertification, this wound is being called a dehisced surgical wound as it was at start of care. Prior to the first flap procedure, the wound was originally a pressure ulcer. The depth is 2 cm and the wound bed is 50/50 granulation/hard black eschar. Wound length is 7cm, width 2cm. Does this remain a dehisced surgical wound or is it now a pressure ulcer since the flap procedure has failed?

Answer: OASIS C guidance indicates that this wound is no longer a pressure ulcer once a flap procedure has been performed. It is a surgical wound. If the current wound began with dehiscence of the flap, it is still a dehisced wound. If the flap had healed and subsequently broken down, it would be a pressure ulcer.

This scenario brings to light an unanswered dilemma … (more…)

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OASIS Toolkit: Use These 4 Steps To Minimize Adverse Drug Reactions

Posted on 26. Jan, 2010 by .

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Following these steps will make M2010 and M2015 easier to answer.

Here’s the most important question to ask yourself about each of the patient’s medications: “Is there a good reason for not stopping this medicine?”

Two new OASIS C process measures will appear on Home Health Compare. M2010 (Patient/Caregiver high-risk drug education) asks if at start of care (SOC) and resumption of care (ROC) you provided instruction to the patient/caregiver about special precautions for all high-risk medications, and how and when to report problems that may occur.

M2015 (Patient/Caregiver drug education intervention) asks if, since the previous OASIS assessment, agency staff or another health care provider instructed the patient/caregiver to monitor the effectiveness of the drug therapy, drug reactions, and side effects, and how and when to report problems that may occur. But before you begin instructing the patient, ask yourself if the patient needs all the medications you’ve recorded on the list of current medications.

Uncover Serious Issue: Failure to Discontinue Unnecessary Medication … (more…)

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Hospice Documentation How-To: What it Takes to Write a Good Physician Narrative

Posted on 20. Jan, 2010 by .

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Good news! Specificity wins over length.

Hospices looking for guidance on how physicians should write their attestations of hospice patients’ terminal illnesses aren’t getting much help from a recent CMS Q&A on the matter.

“We have not mandated that specific language be included in the physician’s attestation,” CMS says of the new requirement that took effect on Oct. 1. “Any language under the physician’s signature which attests that by signing, the physician confirms that he/she composed the narrative based on his/her review of the patient’s medical record or, if applicable, his or her examination of the patient meets the attestation regulatory requirement,” CMS says.

Good and bad news: The physician narrative isn’t tricky, but it can be hard to get physician paperwork, and this is one more thing you’ve got to do, says attorney Marie Berliner with Lambeth & Berliner in Austin, Texas.

Try this: Have a system in place where you track down the doctor to get the signed and dated certification paper work before you bill or you may wind up having to pay, says attorney Connie Raffa with Arent Fox in New York, NY.

This solution works well for some HHAs… (more…)

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Test Yourself: What ‘Flu Season’ Means In OASIS C

Posted on 13. Jan, 2010 by .

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Delve into CMS’s supplemental OASIS C guidance for the answer.

Confusing wording could trip up your OASIS coding for vaccination process measures, if you don’t learn an important distinction. When you answer “yes” to M1040, you’d better make sure four conditions apply.

‘Test Yourself’ Scenario: You are discharging a patient on Jan. 2, 2010, at the end of his second separate episode of care that had a start of care date of Dec.1, 2009. You had already administered the seasonal flu vaccine to the patient on Sept. 25, 2009, during his first separate episode of home care.

Read These Questions and Choose A, B, or C

Question #1: How do you answer M1040 (Influenza Vaccine: Did the patient receive the influenza vaccine from your agency for this year’s influenza season [October 1 through March 31] during this episode of care?) in your discharge assessment?

Your answer options for M1040 are:

0 — No

1 — Yes

NA — Does not apply because the entire episode of care (SOC/ROC to Transfer/Discharge) is outside this influenza season.

After reviewing your options, you can report:

A) 1 — because the patient received this year’s flu vaccine from your agency.

B) 0 — because the patient did not receive the flu vaccine during this episode of care.

C) 0 — because the patient received the flu vaccine prior to Oct. 1.

Question #2: If your answer to question #1 is no, how do you answer M1045 (Reason influenza vaccine not received: If the patient did not receive the influenza vaccine from your agency during this episode of care, state reason).

Your answer options are:

1 – Received from another agency provider (e.g., physician)

2 – Received from your agency previously during this year’s flu season

3 – Offered and declined

4 – Assessed and determined to have medical contraindication

5 – Not indicated; patient does not meet age/condition guidelines for influenza vaccine

6 – Inability to obtain vaccine due todeclared shortage

7 – None of the above

After reviewing your options, you can report:

A) 1 — Received from another health care provider. You choose this because a different clinician administered the vaccine in the previous episode.

B) 2 — Received from your agency previously during this year’s flu season. You choose this because the flu vaccine was given by your agency during the previous episode.

C) 7 — None of the above. You choose this instead of “2” because the patient received the vaccine on Sept. 25 and M1040 says that the influenza season is Oct. 1 through March 31.

Compare Your Responses To These Answers … (more…)

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Brush Up On Your Latin For OASIS C Success

Posted on 05. Jan, 2010 by .

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Note this subtle difference in wording to score OASIS C accurately.

Question: When I read through the OASIS C items, I see that some questions contain “e.g.,” some use “i.e.,” and some have both. Do these variations affect my answers?

Answer: Yes, they do. The abbreviations have specific meanings outside the OASIS data set: i.e.is from the Latin “id est,” meaning “that is,” and e.g. is from the Latin “exempli gratia,” meaning “for example.”

The Centers for Medicare & Medicaid Services used these same meanings within the items, in the guidance, and in the item-specific instructions, according to Chapter 1 of the new OASIS C Guidance Manual. If you see i.e., you know scoring is limited to the items listed, as if it says, “Only in these circumstances,” CMS explains.

M1890 & M1880 Examples … (more…)

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Hospice Print & Save: Direct Quality Improvement with This Compass

Posted on 30. Nov, 2009 by .

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Use this handy chart to direct your quality improvement initiatives.

Benchmarking gives you an opportunity to see how your hospice stacks up against others. Learning where you excel and where you need to improve is invaluable.

Carla Braveman, RN, MEd, CHCE, CEO of Big Bend Hospice in Tallahassee, Fla. shares this simple tool you can use to see if your hospice is on track or if you need to make some course corrections.

Patient/Family Outcomes Quality Measures

• Number of family members who report being prepared for the death

• Falls injury compared to benchmark (more…)

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Test Your OASIS Savvy: M1040 & M1045

Posted on 18. Nov, 2009 by .

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Looking for a staff training tool for M1040 & M1045? Here it is.

Scenario: You are discharging a patient on Jan. 2, 2010, at the end of his second episode of care. You had already administered the seasonal flu vaccine to the patient on September 25, 2009, during his first episode of home care. Read the two questions and choose A, B, or C.

Question #1: How do you answer M1040 (Influenza Vaccine: Did the patient receive the influenza vaccine from your agency for this year’s influenza season [October 1 through March 31] during this episode of care?) in your discharge assessment? Your answer options for M1040 are:

0 – No

1 – Yes

NA – Does not apply because the entire episode of care (SOC/ROC to Transfer/Discharge) is outside this influenza season.

After reviewing your options, you report:

A) 1 – because the patient received this year’s flu vaccine from your agency.

B) 0 – because the patient did not receive the flu vaccine during this episode of care.

C) 0 – because the patient received the flu vaccine prior to October 1.

Question #2: If your answer to question #1 is no, how do you answer M1045 (Reason influenza vaccine not received: If the patient did not receive the influenza vaccine from your agency during this episode of care, state reason). Your answer options are:

1 – Received from another health care provider (e.g. physician)

2 – Received from your agency previously during this year’s flu season

3 – Offered and declined

4 – Assessed and determined to have medical contraindication

5 – Not indicated; patient does not meet age/condition guidelines for influenza vaccine

6 – Inability to obtain vaccine due to declared shortage

7 – None of the above

After reviewing your options, you report:

A) 1 – Received from another health care provider. You choose this because a different clinician administered the vaccine during the previous episode.

B) 2 – Received from your agency previously during this year’s flu season. You choose this because the flu vaccine was given by your agency during the previous episode.

C) 7 – None of the above. You choose this instead of “2” because the patient received the vaccine on September 25 and M1040 says that the influenza season is October 1 through March 31.

Do you know the answers? Read more to find out … (more…)

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Certify Hospice Patients’ Terminal Illnesses With This Form

Posted on 10. Nov, 2009 by .

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We’ve got the handy link you need.

 

If you’re struggling to comply with the new physician narrative requirement that took effect Oct. 1, you don’t have to go it alone.

CMS now requires physicians to include “a brief narrative explanation of the clinical findings that support a life expectancy of [six] months or less” when they certify (or recertify) hospice patients as being terminally ill, according to the final hospice rule published in the August 6 Federal Register.

Good news: Regional home health intermediary (RHHI) Cahaba GBA is helping you streamline this potentially headache-inducing process.

The RHHI offers this sample document* (PDF) as a guideline for all hospices to use as they develop policies and procedures for complying with the physician narrative requirement:

* Cahaba included a disclaimer that each agency must ensure its certification and recertification forms are correct.

Hospice GIP and Continuous Care: From Compliance to Reimbursement. An audio training event with Mary Michal.

 

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Factor These Facets of Bereavement Care Into Your Hospice Programs

Posted on 04. Nov, 2009 by .

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This 9-item checklist helps you achieve a first-rate program.

Hospice-provided bereavement care can provide a broad range benefits to the grieving. According to Theo Munson, MPH, manager of bereavement services for Lifetime Care/Hospice in Rochester, N.Y., a comprehensive program should include the following:

  • Follow-up when professional home visitors predict that the primary caregiver will have a challenging bereavement course.
  • Check in with family members because you can’t always predict how grief will unfold.
  • Convey the message that the patient, family, and staff went through a major event together and that the loss matters to the provider.
  • Remind family members that they don’t have to handle their grief alone — that bereavement care is a choice they have at no expense.
  • Track down answers to nagging questions and address concerns of the bereaved.
  • Educate about symptoms of normal and complicated grief.
  • Prevent and treat post-traumatic stress disorder, isolation, numbing, bitterness, and physical symptoms.
  • Give printed materials and information about resources to turn to when the time is right.
  • Collaborate with administrators to address dissatisfaction with hospice care events.
  • Provide supportive counseling to people who wouldn’t ordinarily access mental health services.
  • Supplement the work of other professional caregivers.
  • Support hospice staff by debriefing them after challenging experiences as well as “picking up the baton” so that the rest of the team feels better about going on to new families and new attachments.

© Eli’s Hospice Insider

Available on CD: Providing Continuous Care in Hospice: Should You or Shouldn’t You?

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Home Health Sample Form: Point Vaccines Toward Your Neediest Patients

Posted on 27. Oct, 2009 by .

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This form will help you make the most of the tools at your disposal.

It’s all over the news: the H1N1 virus is running rampant and both vaccinations and treatment are in short supply.

This could be a potential problem for your patients, especially those at the highest risk for infection, points out the Centers for Disease Control and Prevention. Make sure you have the vaccinations you need — and that you don’t wrongly prioritize your patients’ needs.

Use a form like this one to assess patients’ need for immunization and provide accurate follow up.

© Home Care Week.

AUDIO: Home Health Boot Camp for New OASIS C Process Measures: Session 2. Presented by Judy Adams, RN, BSN, HCS-D, COS-C.

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