Expert Feedback Q&A

Since it’s natural to have more questions about FMS and the solutions we provide, we've asked our experts to address some of the most commonly asked questions here. Of course, feel free to contact us if we have not answered your questions.

• My patient has a history of heart failure that has caused her to be hospitalized three times last year. In the past 6 months, she has been stable with no medication changes and no active symptoms. I would like to keep her on Observation and Assessment (O&A) because I know there is a likelihood that she will go back into heart failure. Is this okay with Medicare?

  • No. The Medicare Benefit Policy Manual, Section 40.1.2.1, states that O & A is reasonable for three weeks. It may be reasonable for longer time periods if there is documentation of unstable condition. Some examples of this would be unstable labs, vital signs, weight changes, edema, or medication changes. The regulation goes on to say that a longstanding pattern of patient’s condition or no attempt to change treatment makes O & A unnecessary.

• May a dentist refer and sign orders for a patient to receive home health care under the Medicare benefit?

  • No. According to Condition of Participation §484.18: Acceptance of Patients, Plan of Care, and Medical Supervision, care follows a written plan of care established and periodically reviewed by a doctor of medicine, osteopathy, or podiatric medicine.

• How many hours of education per year is a home care aide required to complete?

  • The Federal Conditions of Participation, §484.36(b)(2), requires documentation of 12 hours of in-service training per year for home care aides. The training must be more than basic skills and must be supervised by an RN.
     

• Yesterday I was preparing to lock up the office at the end of the day and found copied time sheets in the garbage with patient’s names. A cleaning crew empties all our garbage cans into a nearby dumpster twice weekly. Does this violate our patient’s privacy?

  • Definitely. When any document with Personal Health Information is no longer needed, it should be disposed in a secured document disposal container or shredded immediately.

• What is Medicare?

  • Medicare is a health insurance program for:

    • People age 65 or older,

    • People under age 65 with certain disabilities, and

    • People of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

    Part A Hospital Insurance - Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.

    Part B Medical Insurance - Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

• What is the purpose of the National Provider Identifier (NPI)? Who must use it, and when?

  • The purpose of the National Provider Identifier (NPI) is to uniquely identify a health care provider in standard transactions, such as health care claims. NPIs may also be used to identify health care providers on prescriptions, in internal files to link proprietary provider identification numbers and other information, in coordination of benefits between health plans, in patient medical record systems, in program integrity files, and in other ways. HIPAA requires that covered entities (i.e., health plans, health care clearinghouses, and those health care providers who transmit any health information in electronic form in connection with a transaction for which the Secretary of Health and Human Services has adopted a standard) use NPIs in standard transactions by the compliance dates. The compliance date for all covered entities except small health plans was May 23, 2007; the compliance date for small health plans was May 23, 2008. As of the compliance dates, the NPI is the only health care provider identifier that can be used for identification purposes in standard transactions by covered entities.

• Occupational Therapy can conduct the comprehensive assessments subsequent to the start of care? True or False

  • The Conditions of Participation are silent on who does comprehensive assessments after the start of care. OASIS Guidance Manual: Any discipline qualified to perform assessments-RN, PT, SLP, OT-may subsequent assessments. (Chapter 1, pages 1-8).

• I am an RN and I am responsible for looking at the content of therapy notes. What do I need to focus on in my record review?

  • Therapy evaluations should contain objective measurements for range of motion, strength, balance, as well as assistance needed to complete ADL and IADL tasks. Therapy goals should be measureable and have a functional component, i.e.: Pt. will ambulate from bedroom to kitchen using walker independently to retrieve morning medication safely. Therapy notes should clearly tell a story of what took place during the treatment-patient’s status prior to the treatment, any skill done during the treatment and how the patient responded to the treatment. The discharge summary should contain the goals set and if they were met, and if they were not met, the reason why.

• How often does the PT have to see a patient that is being seen by a PTA?

  • This will depend on the state practice act, as states rules on supervision vary from state to state.

• We have a home health agency in Texas. Are we required to post the Rights of the Elderly in the agency’s office?

  • Yes. On August 31, 2010, the Texas Department of Aging and Disability Services (DADS) issued Memorandum S &CC 10-03 compliance guidance for Home and Community Support Services Agency relating to posting of Texas Human Resources Code Chapter 102, Rights of the Elderly. This revision requires that the Rights of the Elderly be posted in the Agency in an “acceptable conspicuous location”. Failure to post this as directed could lead to administrative penalties which begin at $500.

• I am a volunteer for a hospice agency in south Texas. Recently, the administrator informed me that the agency was required to perform an annual criminal background check. I only go to patients homes once or twice per month. Is this background check really necessary?

  • An agency must conduct a criminal history check authorized by, and in compliance with, Texas Health and Safety Code (THSC), Chapter 250 (relating to Nurse Aide Registry and Criminal History Checks of Employees and Applicants for Employment in Certain Facilities Serving the Elderly or Persons with Disabilities) for an unlicensed applicant for employment and an unlicensed employee. The agency must not employ an unlicensed applicant whose criminal history check includes a conviction listed in THSC §250.006 that bars employment or a conviction the agency has determined is a contraindication to employment. The criminal history check must be performed at least every 12 months for unlicensed employees who have face-to-face encounters with an agency’s patients. The provisions in this subsection apply to an unlicensed volunteer if the person's duties would or do include face-to-face contact with a client.

• I'm in Texas and last week, one of my patients said she thinks the home health aide may have stolen some money from her purse. When I told the patient that I would report this to my supervisor, she begged me not to tell and said "just forget it". Am I obligated to report this?

  • Yes, you must report this. The Texas Administrative Code, Title 40, Chapter 97.249 outlines the regulation regarding abuse, neglect, and exploitation (ANE) of a client by an employee of the agency. It states that if an agency has cause to believe that a client served by the agency has been abused, neglected, or exploited by an agency employee, the agency must report information immediately. Texas regulations require that your agency has a policy on ANE and enforces it.

• Can you share some helpful websites with me?

  • Absolutely:

    • www.alz.org

    • www.osha.gov

    • www.americanheart.org

    • www.mayoclinic.org

    • www.tahc.org

    • www.NAHC.org

    • www.CMS.gov

    • www.dads.state.tx.us