Term
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| A 485 is a document facilitating a patient's orders for home care on CMS form number 485 entitled Home Health Certification and Plan of Care. This plan of care must be established and reviewed at least once every 60 days by the patient's attending physician. |
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Term
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Definition
| Updates to the 485 are placed on this particular CMS document |
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| A supplemental form that holds any additional information that does not fit on the 485. |
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Term
| Who is the primary caregiver for home health? |
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Definition
| The primary caregiver for the patient on home health varies on the patients needs it can be skilled nursing services employee or home health aides or both. |
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Term
| What is OASIS? What do they do and when ? |
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Definition
| OASIS stands for Outcomes and Asscessment Information Set. A data set requirement under Medicares Conditions of Participation . Medicare certified home health agencies collect and use OASIS data when evaluating adult , nomaternity patients. The intent of OASIS is to make the Conditions of Particpation more patient -centered and outcome oreintated while providing home care agencies with more flexiblity to operate their programs. It also measures treatment outcomes and provides individual agencies with the ablity to compare themselves to the national data. |
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| What percentage of time is covered by volunteers in home health? |
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Definition
| There is no set % of volunteer time for home health care it varies on a case by case basis . Depends on the level of care the patient needs. |
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Term
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Definition
HHRG stands for Home Health Resource Group and there are 153 groups . It is the equvilent of a DRG for diagnosis codes. Patients are assessed in three areas to determine the HHRG :clinical , Functional , Service Utilization
1. Clinical : evals the pts medical status by assessing primary diagnosis, vision, level of pain,presence of ulcers, dyspnea, urinary, and bowel status, need for infusion, and behavior.
2.Functional : asscess the pts ability to perform activies of daily living . Dressing , bathing , eating , toileting , transfering and ambulation.
3. Service Utilization:determines what level of service the pt is likely to need based on location at the time of the home care referral(home, hospital,skilled nursing ) and whether there will be a need for 10 or more therapy visits in the next 60 days.
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Term
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Definition
| HAVEN stands for Home Assessment Validation and Entry. It is software that CMS developed to provide home health agencies with software for data entry, editing , and validation of OASIS data. The data is encoded and locked within 7 days of the assessment . CMS requires the data be electronically transmitted at least monthly . |
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| RAP stands for Request for Anticipated Payment . It looks at OASIS plan for care and makes an advanced payment upon what they think the level of services might need then when the payment from the claim is submitted the difference if any is taken out. |
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Term
What is the coding ICD9-CM for Home Health?
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Definition
The home care prinicipal diagnosis is the diagnosis most related to the plan of care and is recorded on the 485. If the principal diagnosis has changed by the time of the next recertification (60Days) , the code for the new principal diagnosis is recorded on the 485.
OASIS forms are now required to report V and E codes . The V code is the primary diagnosis code and the non V code can be used to determine the application of the HHRG.
DME or durable medical equipment companies requires ICD9-CM codes for payment as well. |
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Term
| What is the CPT coding for home health? |
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Definition
| This is the coding for the physicians who must keep their own records documenting the time spent per patient on care plan oversight because time spent provides the basis for payment. |
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Term
What is the recertification period for home health?
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Definition
| The pts physician must review , update, and recertify (if necessary) the plan of care at least every 60 days. This time frame is often referred to as Recertification can continue every 60 days until the patient is discharged from services. |
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| What is the medical record periodic reviews for completeness time for home heath? |
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Definition
| Review should happen within 10 days of admission for : transferring services, assessements , plan of care, and consents. Continual reviews should happen every 30-60 days for completion of records . |
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Term
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Definition
| CHAP stands for Community Health Accrediation Program . It was establisbed by nurses in 1951 and is the equvialent to JACHO . |
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Term
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Definition
| OBQI stands for Outcomes based quality improvement -targets areas for improvement (looks for a process to do things better) |
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Definition
| OBQM stands for outcomes based qualtiy management . It monitors for continous quality outcomes . |
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| What is Utilization in home health care do ? |
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Definition
| Aligns services and skills with the patients needs , controls cost , and optimize outcomes. ( right services to the right patient but also the amount or length of time. |
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Term
| What does Risk Management do for home health? |
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Definition
| Because of the uniquness of the remote workforce risk management gives standard training requirements to all facility based staff. It gives community and self denfense training . Secure records in locked brief case/password protected pc. |
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