Transcript The Meaning of Home Healthcare

The Meaning of Home
Healthcare
Home Healthcare is for those individuals
who may require assistance during an illness
or after surgery. Services are provided in the
comfort and privacy of one’s home to those
persons who are in need of nursing, therapy
services to include: PT, PTA, OT, COTA,
SLP, social services and/or assistance with
the activities of daily living.
“That’s why we’re here – to help people.”
Our Home Health Team
The Skilled Care will be performed by a Case Manager
who will be active in all aspects of patient care from
admission to discharge from the Agency
• Patient and their Family
• Patient’s Physician
• Medical Director
• Therapy
• Licensed Social Worker
• Home Health Aide
• Medical Equipment Supplier
• Home Health Bridge Team if needed
Services we provide
Services we provide
Nurses
(Registered Nurses & Licensed Practical Nurses)
Physical Therapists
Physical Therapist Assistant
Occupational Therapists
Certified Occupational Therapist Assistant
Speech Therapists
Medical Social Workers
Home Health Aides
Homemaker
Nurses
Registered Nurses & Licensed Practical Nurses
Home healthcare Nurses provide at-home
nursing care for patients, often as followup care after discharge from a hospital or
from a rehabilitation, long-term care, or
skilled nursing facility.
Examples of Skilled Nursing Billable Tasks
•Infusion Therapy
•Medication Management and Education
•Diabetic Teaching
•Pediatrics
•Wound Care
•Wound Vacs
•Home Safety and Emergency Education
•Ostomy Care
•Injections
•Catheters
•Enteral and Parenteral Nutrition
•Tracheostomy Care
•Patient and Family Education on Disease Process
•Venipuncture
Physical Therapists
Home healthcare Physical Therapists provide
treatment to individuals to develop, maintain
and restore maximum movement and function
throughout life. This includes providing
treatment in circumstances where movement
and function are threatened by aging, injury,
disease or environmental factors.
Examples of Physical Therapist Tasks
•Perform physical therapy procedures, evaluations and
diagnostic tests on clients
•Translate all exercises into functional activities or
activities of daily living
•Teach basic principles of good posture and body
mechanics
•Fall Prevention
•Home Safety and Education
•Stretching and Range of Motion
•Balance and Endurance
Physical Therapist Assistant
Physical therapist assistants help physical
therapists to provide treatment that
improves patient mobility, relieves pain,
and prevents or lessens physical disabilities
of patients.
Examples of Physical Therapist Assistant Tasks
•Administer non-complex therapeutic exercises
•Therapeutic massage
•Traction
•Report changes in the clients condition to
supervising PT
•Endurance and balance training
•Assistance with walking
Occupational Therapists
Home healthcare Occupational Therapists
work with individuals, families, groups and
communities to facilitate health and wellbeing through engagement or reengagement in occupation.
Examples of Occupational Therapist Tasks
•Guide and instruct the client in prescribing
therapeutic self care
•Establish household management routines
•Instruct clients and their families in activities and
any devices needed to perform tasks such as
dressing, bathing, and eating
•Evaluate and make recommendations to ensure
proper seating with wheelchair and stationary
seating
Certified Occupational Therapist Assistant
Occupational therapist assistants
work under the supervision of
occupational therapists to provide
rehabilitative services to persons with
mental, physical, emotional, or
developmental impairments. The
ultimate goal is to improve clients'
quality of life and ability to perform
daily activities.
Examples of Certified Occupational
Therapist Assistant Tasks
•Perform OT procedures planned and
delegated as prescribed by the
physician
•Assist clients to and from treatment
or training areas
•Instruct client in pushing wheelchair,
supporting or lifting and positioning
in and out of bed
Speech Language Pathologists
Home healthcare Speech Language
Pathologists assess, treat, and help to
prevent disorders related to speech,
language, cognitive-communication,
voice, swallowing, and fluency.
Examples of Speech Therapy
Tasks
•Assist the physician in evaluating level of function
•Administer diagnostic speech and language evaluations
•Provide direct speech service to clients under a physicians
plan of care
•Evaluate reading and writing skills
•Evaluate and treat speech, voice, swallowing, and chewing
skills
•Evaluate and treat patient’s in attention span, memory, and
judgment, problem solving and organizational skills
Medical Social Workers
Home healthcare Medical Social Workers assess the
psychosocial functioning of patients and families and
intervene as necessary. Interventions may include connecting
patients and families to necessary resources and supports in
the community; providing psychotherapy, supportive
counseling, or grief counseling; or helping a patient to
expand and strengthen their network of social supports.
Examples of Medical Social
Worker Tasks
•Assess, when appropriate, a family’s
financial situation
•Counsel, support, mobilize, and work
with clients and families to ensure basic
human needs
•Assess allegations of abuse and neglect
Home Health Aides
Home Health Aides assist elderly, disabled, and
ill patients to live in their own homes rather than in a health care
facility. HHAs contribute to the
efficiency and quality of the health care system.
The primary role of the HHA is to perform assistive duties, such
as personal hygiene, grooming,
transfers (bed to chair), range-of-motion exercises (moving the
joints), and proper positioning of
the patient.
Examples of Home Health Aide
Tasks
•Provide essential personal care such as bathing,
dressing, shaving, and oral care
•Document care and record vital signs
•Report any changes in patient condition to Case
Manager i.e.: RN, PT, SLP, OT, or DON
**To have a Home Health Aide in the home
through Home Health the patient MUST have a
clinical discipline in the home**
Homemaker
The homemaker performs tasks that contribute to
client’s comfort and safety in the home which
include companionship, socialization, and
housekeeping services. They also assist with
personal care and nutrition.
Examples of Homemaker Tasks
•Assist with personal care
•Assist with Nutrition
•Assist with peri-anal care
•Assist client to live in clean, safe
environment
Documents Needed for
Processing a New Referral
Information requested to the source
when accepting a NEW referral
History and Physical
Demographics (to include current address and phone numbers)
Doctor’s Orders
To include discipline and service to be performed
Examples:
•
SN for wound care
•
SN for Foley catheter care
•
SN for NEW med teaching/monitoring
•
PT for home exercise program
•
PT for strengthening
•
SLP for safe swallowing
•
OT for improved ADL’s
•
HHA to assist with ADL’s
•
MSW for community resources
Insurance information
Insurances
Insurances
Insurances that are accepted: Please NOTE*
MUST check eligibility on ALL accepted
insurances to verify the PRIMARY insurance.
•Medicare (no prior auth required)
•NM Medicaid (Admission visit automatically
authorized).
•Molina (Admission visit automatically
authorized).
•Molina SCI (state coverage insurance) Prior
authorization is required PRIOR to ANY services
being rendered
Continued
•Gentiva (Prior auth required before any services rendered;
Referral usually comes from Gentiva with auth attached)
•Lovelace (only through Gentiva, Prior auth required before
any services rendered and referral must be called in to
Lovelace/Gentiva by referral source
•Cigna (only through Gentiva, Prior auth required before any
services rendered and referral must be called in to Gentiva by
referral source)
•Pres. Salud (Prior auth required prior to admit, referral should
come from Pres.)
•Pres Sr. (Prior auth required prior to admit, referral should
come from Pres.)
Continued
•Workman’s Comp (prior auth required before any services rendered)
•AIG Workman’s comp (prior auth required before any services
rendered)
•Southwest Administrators Workman’s Comp (prior auth required
before any services rendered)
•Mutual of Omaha (prior auth required before any services rendered)
•Woodward Health Care (prior auth required before any services
rendered)
•Conseco Insurance (prior auth required before any services rendered)
•D&E Waiver (all referrals must be directed to Waiver Intake)
•Humana – in network provider (prior auth required before any
services rendered)
•United Health Care – in network provider (prior auth required before
any services rendered)
Continued
•Evercare – Initial Admission Visit automatically authorized; in
network provider
•Amerigroup – Initial Admission Visit automatically authorized; in
network provider
•Tricare/Triwest – Ins does not require contract (prior auth required
before accepting referral)
•BCBS – in network provider (prior auth required before services
rendered
For out-of-network providers, please notify referral
source that co-pays and benefits are different for
patients with out-of-network providers.
Face 2 Face Encounter
As a condition for payment, the Affordable Care Act requires that, prior to
certifying a patient’s eligibility for Medicare Home Health services, one of
the following providers must have a F2F encounter with the patient that
occurs no more than 90 days prior to the Home Health SOC date or within
30 days after the SOC.
• The certifying physician
• The physician who cared for the patient in an acute or post-acute
setting and has admitting privileges; or
• An allowed non-physician practitioner (NPP)
The following NPPs may perform the F2F encounter:
• A nurse practitioner or clinical nurse specialist who is working in
collaboration with the certifying physician in accordance with State
Law;
• A certified nurse – midwife as authorized by State law; and
• A physician assistant under the supervision of the certifying physician
Homebound Status
A patient’s residence is wherever he or she makes his or her home.
For a patient to be considered confined to the home, the condition of the
patient is such that:
• There exists a normal inability to leave the home; and
• Leaving the home would require a considerable and taxing effort
The patient may be considered homebound if absences from the home are
infrequent, for periods of relatively short duration, or for the need to
receive home care treatment. In general, a patient is considered
homebound when leaving the home is medically contraindicated or he or
she has a condition due to an illness or injury that restricts the ability to
leave the place of residence excepts with the aid or assistance of:
• A supportive device (i.e: crutches, cane, wheelchair, or walker);
• Special transportation; or
• Another person
An Individual would NOT be
considered Homebound if…
• Leave the home frequently for social activities
• Go to day care center for non medical purposes
or to a relatives house part of the time (except
for Alzheimer's specific day care center)
• Leave the home against physician orders, if
this is done frequently or for long periods of
time
• Leave the home for shopping or business on a
regular basis
Medicare will pay for Home Care Visits when the
Following Criteria Has Been Met…
• The patient must be enrolled in the Medicare program during the time the
services are provided and be eligible for benefits
• A Medicare certified agency must provide services
• A physician who establishes and periodically reviews the plan of care at
least every 60 days must order the services
• The patient must be homebound
• The services must be medically reasonable and necessary to the treatment
of an illness or injury
• The patient must need a qualifying skilled service (Skilled Nurse, Physical
Therapy Speech Therapy, on an intermittent basis or continued care from
an Occupational Therapist)
• If at least one of the qualifying services is needed, Medicare covers the
following services: Medical Social Services, Medical Supplies, and Home
Health Aide
Your Home Health Contacts
Tina Hans, RN,CHCA
Home Health Executive Director
[email protected] / 505-720-7956 or 505-861-0060x10408
Maria Nieto, Community Liaison
[email protected] / 505-244-0046x11154
Mitzie Schoeppner, Community Liaison
[email protected] / 575-556-8409x12417
Your Home Health Admission
Coordinators
Megan Konopka
[email protected] / 505-244-0046 x11152
Robert Trujillo
[email protected] / 505-244-0046 x10444
Samuel Martinez
[email protected] / 505-244-0046 x11143
Home Health On Call Procedures
A nurse is available 24 hours a day/ 7 days a week
The on call nurse / DON / Executive Director can be
reached after hours, on weekends and holidays by
dialing the main phone to the office:
1-877-861-0060