Home Health Documentation Examples: Fill & Download for Free

The margins in home health are razor thin in the USA. It is very complex but let me give you a very simplified overview of just some of the factors. They are interconnected, so there is overlap and synergy between those factors. I’m going to draw on a lot from CMS (Center for Medicare and Medicaid Services) type approach but it follows for a number of insurers in general. Realize also that in the US, we have thousands of the beasties, all with their own forms and processes, which is its own form of hell when trying to get authorization. More about that later.Patient populations.People who need home health are too sick to go to a clinic or doctor’s office for care. The criteria is usually called “homebound”. The patient can only leave the home with difficulty and can’t get care in other settings, therefore, the home is the site of the care.Such persons are usually but not always elderly. They often have multiple or complex medical conditions/disease states and treatment regimens. Thus, their care needs are complex. Some of these needs are reimbursable (more later again), some are not. But when you take someone on service (aka admit to service), you provide care, whether it is reimbursed or not, whether you knew what you were getting into when you agreed to care for them or not. Abandonment is a legal and ethical no no. So is shoddy care. The people doing the reimbursing reimburse for how much it should do to provide care for X. The fact that the patient also needs A, B, K, R and T is your problem as the home care agency/health care provider. Social, mental health and such needs are rarely reimbursable.Patients have been discharged quicker and sicker for decades now and with more complex treatment regimens for the patients and caregivers to master. Part of what home health care involves is transferring care to the patient and/or designated caregivers. If the person needs more than intermittent care, there is no caregiver or the patient is not able to perform the care, then the patient may have to go to a nursing care facility. This may be short or long term. Home health care is not round the clock care unless the patient or family pays out of pocket. Insurance companies don’t do that (rare exceptions). Home health providers are supposed to put themselves out of a job if possible. More on that in a bit.If there is a caregiver. Caregivers must be ready, willing, able, and available. Ready means that they must be able to be taught/prepared to assume whatever caregiving role or task is needed by the patient. It may be medication or symptom management, a dressing change or what have you. They must be willing to do it. If you faint at the sight of needles, then you may not be willing to draw up and inject a diabetic patient’s insulin twice a day after doing four times a day finger sticks to monitor blood glucose levels. Able is another aspect. If the caregiver has a physical or cognitive impairment for example, they may be willing and available but can’t be made ready or able to provide care. Finally, many families are scattered geographically or have work or other responsibilities that mean they may not be available to provide care.Another thing you see is underage children providing care for parents (no no) but it happens and older couples who are barely functional as a whole person together. When one has an event, the situation falls apart and both need help. I have had situations where I have gone into a home and admitted both people to service instead of just one.Insurance/ReimbursementForms- The process is extraordinarily complex. In the USA, we do not have a single payer system. We have thousands of payers, all with their own rules and forms. Many are now electronic. We also have varying reimbursement by insurer, by healthcare plan (so that if I have patient A, who works for company #1, changing the hydrocolloid dressing on his diabetic foot ulcer will be reimbursed 1.23$. However, for the same insurance company, patient B, who works for company #2 and has the same issue, the reimbursement will be 1.01$ because of how the health plan was negotiated). And none of this will be clear until I submit the bill usually. And get paid months later after submitting a ton of documentation. Which will be challenged.Let’s all play Utilization Review. UR is important. It is designed to hold down costs and make sure unneeded services or errors such as duplicate documentation are dealt with. The insurance company employs people, usually nurses, to go over the patient’s medical records to make sure that only what was authorized, in alignment with what was documented, and to catch those sorts of errors is paid for. Anything else is flagged and sent back. The provider also has UR people to find the same thing, make sure that what is sent to the insurance people is going to go thru so that the payment comes back and will hunt down the nurse, doc, PT, whatever to make sure their documentation is up to snuff. Back and forth it goes. In the meantime, it can take months after a service has been provided for actual payment to be received. Which is a tough way to run a business. And health care types are notorious for not documenting well/for payment.Authorization process. When I admit a patient to service there is a process.First, there is an intake. This can be via a call or a discharge planning nurse/case/care manager in the hospital or rehab/long term care facility can make arrangements on site. Some agencies have home health nurses who go to the facility to do an initial intake. The process gathers certain initial crucial info such as demographics, contact information, permission to visit, medical information and so on.The initial visit is usually several hours long. A thorough history and physical examination is conducted. An environmental assessment is performed. Any care needed is provided. Usually a registered nurse provides the initial visit but not always. It depends on what the patient needs.Based on this, a plan of care is developed. This plan of care is discipline specific and written up using specific languages. The languages I refer to are things like ICD-10 What is ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) ? - Definition from WhatIs.com . It has to tell a coherent story of the patient and use specific forms and formats to do so. For example Kathy Quan RN BSN describes the OASIS dataset used in home health reporting to Medicare. It is mandatory.Which is another point, the number of mandatory rules and regulations in home health (and hospice for that matter) is mind boggling. Compliance is not cheap. Dotting all the is and crossing all the ts is time consuming and takes quite a long time to learn. And when you have, they change it. All of which is another source of expense. And if you don’t do it right, they kick it back to you to redo, meanwhile, you aren’t being paid.Okay, this is just for starters. I could add equipment, which they may also decide is not needed (but if they patient needs it, still has to be provided), staffing costs (pay is less than hospital by significant amount and hours long), and keep going but I think this is a start. Running a home health agency is not easy. Many went out of business in the 90s and more in various waves since. A current factor is the policy of readmission to service or admission to hospital with certain conditions being taken as a sign of poor care. For example, if you have a patient with congestive heart failure who is admitted to the ER with an acute exacerbation of their condition within so many days of discharge from service, than it was your fault. You won’t get paid. Even if the patient was nonadherent and that is why they were discharged from service. Doesn’t matter. All on you.Entire books are written on this. Other home health peeps, please chime in. I’m very rusty.

Good question! There are basically two types of insurance available today, they are life and general insurance. I will explain both to give you a better understanding.Life insurance - is of many types such as term insurance, endowment insurance, ULIP, moneyback policies, etc. They all cover your life and provide compensation in case of an unfortunate event. They just differ in the way they function. For example, term insurance is the most basic type of cover - it only provides a payout in case of death. Endowment policies offer some return on investment whereas ULIPS are a combination of life insurance and mutual fundsGeneral insurance - is of many types such as travel, home, health & motor insurance. You can guess their purpose from their names - health insurance cover medical expenses, travel insurance protects you from the financial cost in case things go wrong on your trips, motor insurance covers damages & total loss of your vehicle in a number of instances & home insurance protects the structure & contents of your home. This is why general insurance is so important, it covers all the things you hold precious in your life.All types of insurance are important - they protect your life and your valuable assets and keep you safe from major financial strain. Life and health insurance also have tax benefits that will help you save money as well. Motor insurance is one of the compulsory general insurance plans. You need to have at least third-party motor insurance if you own a bike or car in India.Both are best bought online - if you need to buy general insurance or life insurance, it is best that you purchase it online. This helps you avoid middlemen and allows you to make the purchase at your convenience. You do not have to visit a branch, fill an endless amount of form or submit a stack of documents.I hope this has been helpful, good luck and all the best!

This just happened a couple weeks ago. I have many connections in our area, and sometimes get calls asking if I am accepting new clients, or if I know any home health care providers that are available. I got such a call, but it was strictly a cleaning job. The elderly gentleman was still in a convalescent hospital, and would be remaining there for a few more weeks. So I said I would do the job to pick up some extra money for Christmas. I am given a number of the mans daughter who lives in the South. I called her …very nice lady. We chat awhile and discuss what she would like me to do. She tells me to go look at the apartment and give her an estimate. She said the apartment manager had gone in and removed food that had become spoiled, taken trash out, etc.Upon arrival at his apartment, I opened the door, and knew the manager had not removed any food, or cleaned up in any way. It stunk! Horribly! There were gnats all over everything, windows were shut tight, and the air conditioner had been shut off. The air was thick. I opened up windows, turned on the air conditioner and set a large fan to exhaust the air out the window. I went home, got gloves and masks and a wheelbarrow. Thankfully, the building had an elevator because the apt. was on the 4th floor. The gentleman had been quite ill, and had bags of garbage that the manager had supposedly removed. Gloved and masked, I removed bags of garbage, soiled laundry, and emptied the rotten food from the refridge. I left the fan exhausting the air out, windows open and left the apartment to air. The stench was horrible. I called his daughter from home and told her what I found when I went inside. I gave her my estimated price to clean up and she nearly doubled my estimated cost. She said she appreciated the help since she was so far from from him. So, I work the next 3 days getting the apartment cleaned up. Everything I need, she orders online and I pick it up. Curtains, sheets and cleaning supplies ..she makes sure I have it available.I finish the apartment, and message her with pictures. She is well pleased and actually sends me a money.order for more than her initial promised payment. I had to admit, the apartment was terrible and I had earned every cent of that money order.We had messaged every day, and had developed a bit of a friendship. I was pleased when she continued to message me. One of my dogs had been ill and she continued to ask for updates. Her daughter was getting married, so I continued to ask how things were progressing. Frankly, i found her funny and a pleasent part of my day.A few days later, she messages me to say they plan to discharge her dad the next day! She is in a panic. I am still working.full time and I tell her I will try to help if I am able to. She had planned to be present when her Dad was discharged, but his release date would be the day of her daughters wedding! I tell her to calm down. That I will work it out to be there when they bring him home. I tell her to enjoy tge wedding and Ill manage things here. She thanks me profusely.She orders groceries to stock his kitchen and i pick them up. I make a final check of the apt, and get everything all set for his homecoming the following afternoon.I work my ususual shift, then go to meet the gentleman and get him situated. I have talked with his daughter, and the facility where hes been living about his condition and what he will need going forward. They give me a glowing report of his condition.So, I wait for them to arrive. They arrive a full 90 minutes late. Well, things happen. I head downstairs with his walker that he used prior to his admission. As I approach the van, I rushed by a lady to give me a report on what he needs to be safe in his home. I am looking past her and watching the transfer taking place. The attendant is fully lifting him into a wheelchair. I comment that the intention is that he is self sufficient as he was when he was admitted initially. I walk past her to get a better look at whats going on. I see a very stooped man who is not at all alert. I squat down and call his name. He slightly moves his head. Thats enough for the convalescent staff! They begin to load into the van to leave. I stop them. I am not going to assume responsibility for his care when he is obviously not capable of being alone. The nurse says he is just tired and probably needs to eat some lunch ..it is almost 4 pm, and he hasnt eaten since noon and he is diabetic. So I tell her I need to test his blood sugar before i accept him to stay there. I tell her ill be right back. I take his walker back upstairs and grab his sugar tester unit and some juice. I hurry back and walk out to discober the van is gone and here sits the gentleman all alone. They left him in the full sun all alone. I drag his chair into some shade and test his blood sugar. It is extremely low. I try to get him to drink and he is unable to. I think …shit! This man is going to pass away right here! Thankfully, an elderly lady walks toward us and she offers to help me get him inside into the air conditioned lobby. I have left my phone upstairs and she doesnt have one either. She is pretty strong and able to push his wheelchair as i keep him from slumping out of his chair. I get to the elevator and he starts to come around slightly. He can at least sit back in the chair enough to not fall forward. I thank the lady.profusely and I am able to get him on the elevator. I just need to get to my phone. We get to his place and he seems a bit more alert. I ask if he can eat something. He nods yes. I quickly help him sip some juice. I grab him some cheese and lunchmeat and an.orange. He nibbles a bit. He seems a bit more alert. I grab my.phone and call 911. We have no insulin. I was going to pick it up after he arrived ..never suspecting he would be dumped at the curb in such a condition. The paramedics arrive and take his vital signs and retest his sugars. Vitals are all low. Very low. Sugar is better, but still dangerously low. I call his daughter, who should be enjoying her daughters wedding reception. She answers that she hopes her Dads transfer had gone better than the wedding had ..well, no.actually. I explain the saga, and hand her off to the medics. They explain that he needs to be taken to the emergency room to be stabilized. They let her know in no way was he stable enough to have been discharged. That he was just now beginning to be able to speak. As I am standing there, I notice that he has a foley cath hanging from the chair. I look at his discharge paperwork and it simply doesnt mention this.It is agreed that he goes to ER to be further checked out. So they load him up and head off. I clean up the bit of a mess and I lock up and head for home after taking screen shots of his discharge paperwork from the convalescent hospital. I wanted evidence that I had never signed them. I send copies to his daughter through messenger. According to the documents, he was completely independent with his transfers. His diabetes had been controlled with diet and no insulin. Also stated he was independent with his bowel and bladder needs with no mention of a Foley cath. She was blown away by the documentation and assured me that she appreciated all I had done and that I was proactive in getting him help.The following morning, I have a message from her. Her Dad had taken a turn for the worse, and he passed away in the early morning hours. I was blown away with the news.He should have never been released. He certainly wouldn't have been safe without someone being there with him. I feel so bad for his daughter.We continue to chat online. I dont know if she will pursue this with the convalescent hospital or not. She is certainly justified, but it wouldn't bring her Dad back.