This situation is challenging for us as well.
We have tried to take a proactive approach verses a reactive one (learning of conflicts on documentation review) with regards to these situations. What has helped us is ensuring the admitting clinician has information
on what the primary reason for home health services is as listed on the face to face encounter. They often have a large about of research to do reviewing the H&P/medical documentation/orders, etc before a (SOC) visit so it’s been helpful to highlight this
information separately. This way if the primary reason for home health at the time of referral differs from what the clinician feels is the primary focus based on the assessment visit they can move that information forward right away.
I agree with Vickie- We look at all these cases individually and determine the best plan. For unexpected changes in the focus of care, we would contact the provider, communicate the new concern (e.g. a new wound),
and assist with scheduling a face to face encounter visit (in clinic or telehealth) as soon as possible. Telehealth face to face encounter visits tend to be the quickest way to get a new face to face encounter, orders for wound treatment, a new diagnosis for
etiology of wound, etc so we can update the OASIS assessment/485.
Hope this helpsJ
From: medicarewkgp@list.mnhomecare.org <medicarewkgp@list.mnhomecare.org>
On Behalf Of Leo Monterola
Sent: Friday, February 11, 2022 5:07 PM
To: Brand, Vickie K <Vickie.Brand@allina.com>; medicarewkgp@list.mnhomecare.org
Subject: *External Email Message*RE: F2F question
Hi Vickie,
Thanks for the input! Yeah, it would be iffy for the f2f and the primary reason to not match the primary diagnosis. We’d ideally want to be reimbursed according to the resources we are allocating which is higher for wounds.
Can the new F2F encounter be used to support the shift in primary focus/Dx in the 485?
Thanks!
Leo John Monterola
|
Clinical Administrator | Optage
2845 Hamline Ave. N., Roseville MN 55113
Office: 612-248-4966
E-mail:
lmonterola@preshomes.org
Referral Fax: 651-746-2787, Referral Email:
referrals@optage.org, Referral Phone:
651-746-8200
Office Hours 7:30-4:00 Monday- Friday
Optage®
is the home and community services division of Presbyterian Homes & Services.
Visit
www.Optage.org
or call 651-746-8200 for more information about the following services:
- House Calls
- Care Management
- Hospice
- In-home Care and Services
- Senior Dining Choices
From: Brand, Vickie K <Vickie.Brand@allina.com>
Sent: Friday, February 11, 2022 4:37 PM
To: Leo Monterola <lmonterola@preshomes.org>;
medicarewkgp@list.mnhomecare.org
Subject: RE: F2F question
Hi Leo,
I’m just getting around to looking at some old emails.
I think all of us struggle with that issue of occasionally not having the f2f encounter reflect the primary skilled need identified at the SOC.
I think there is a judgement call that can be made. The regulations state that the f2f encounter has to be related to the primary reason the patient requires HH, not the primary diagnosis. At the time of the
referral, in your example below, the primary reason for the home health referral was a UTI and documentation can support that you will manage the UTI, but that you also discovered a wound which will be managed by home care as well.
Alternatively, you could ask for another f2f encounter (via telehealth if appropriate) to address the wound issues. This would probably be the safest route to go.
I would love to hear if others have opinions on this issue. We look at each of these situations individually. But I 100% agree that this is a hard call to make!!!
Vickie
Vickie Brand, BSN, RN, PHN
Lead Compliance Specialist, Home Health & Hospice
Allina Health Home Health
Mail Route 10733 • 2925 Chicago Avenue, Minneapolis, MN 55407
Hours: Mon, Wed, Thurs 5:00 am-3:30 pm
From:
medicarewkgp@list.mnhomecare.org <medicarewkgp@list.mnhomecare.org>
On Behalf Of Leo Monterola
Sent: Tuesday, February 8, 2022 4:15 PM
To: medicarewkgp@list.mnhomecare.org
Subject: [External Mail] F2F question
CAUTION: This email originated from outside of the Allina Health network. Do not click links or open attachments unless you recognize the sender and know the content is safe.
Hi Team,
In relation to F2F, one thing that we struggle with is matching skilled need with what the F2F visit was for. An example would be getting a referral for UTI and discovering upon assessment that client has as stage 2 PU which becomes a bigger
focus. We have skilled need but we can’t code wound as primary based on F2F encounter. If there was a shift of focus from what was referred to in the first place, how do we match new focus of care to face to face? Will it have to be after the fact at recert?
What if we heal the wound before recert?
Looking forward to hearing from you!
Thanks!
Leo John Monterola
|
Clinical Administrator | Optage
2845 Hamline Ave. N., Roseville MN 55113
Office: 612-248-4966
E-mail:
lmonterola@preshomes.org
Referral Fax: 651-746-2787, Referral Email:
referrals@optage.org, Referral Phone:
651-746-8200
Office Hours 7:30-4:00 Monday- Friday
Optage®
is the home and community services division of Presbyterian Homes & Services.
Visit
www.Optage.org
or call 651-746-8200 for more information about the following services:
- House Calls
- Care Management
- Hospice
- In-home Care and Services
- Senior Dining Choices
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