Follow
Publications: 91 | Followers: 0

Home-Health-Review-Tool-08-30-17

Publish on Category: Birds 0

Note Deny/Non-Affirm reason (continue to step 2)
No
No
No
.
.
No
F2F Encounter RequirementARE MET.Proceed to Step 2(Plan of Carerequirements)
No
* Face-to-face encounter note can include progress notes, discharge summary, etc.**Please refer to 42 CFR 424.22(a)(1)(v)(A) for detailed information on who can perform the face-to-face encounter.
Yes
1Is a Face-to-Face Encounter note*present?
NO
YES
Yes
1.1Was the Face-to-Face Encounter note signed anddatedby anallowed provider type**?
YES
NO
Yes
1.2Was the Face-to-Face Encounter performed by an allowed physician or NPP**?
YES
NO
1.3Does the Face-to-Face Encounter progress note indicate the reason for the encounter was related to the need forhome health services?
Yes
NO
YES
Yes
1.4Is the Face-to-Face encounter note dated between 90 before or 30 days after the start of home health services?
NO
YES
Home Health Review ToolStep 1 (Face-to-Face Encounter Requirement)

Yes
.
.
Plan of Care RequirementsARE MET.Proceed to Step 3 (Homebound)
Yes
Yes
No
2IsPlan of Carepresent?
NO
YES
No
2.1Is the plan of care signed and dated by the certifying physician?
Yes
NO
YES
No
Yes
2.2Does the Plan of Care addressallpertinentdetails as describedin 42 CFR §484.18(a) including:Diagnoses;Mental status,Types of services and equipment requiredFrequency of visits,Prognosis,Rehab potentialFunctionallimitationsActivities permittedNutritional requirementsMedications and treatmentsSafety measures to protect against injuryInstructions for timely discharge or referral,Any other appropriateitems
YES
NO
2.3bDoes the Plan of Careaddress;Specific procedures and modalities,Measurable therapy treatment goals,Frequency and duration of services
NO
YES
Yes
2.3aDoes the Plan of Careinclude therapy services?
NO
YES
No
Note Deny/ Non-Affirm reason (continue to step3)
Step 2 (Plan of Care Requirement)
Yes
.
.
HomeBoundRequirementIS MET.Proceed Step 4(Need forSkilled Care)
*In determining whether the patient meets criterion two of the homebound definition, the clinician needs to take into account the illness or injury for which the patient met criterion one and consider the illness or injury in the context of the patient’s overall condition.
3.1 (Criteria ONE)Does the physician/facility documentation indicate that the patient requires a:mobility assist deviceorspecial transportationorassistanceof another personto leave the home orhas a condition that leaving home ismedically contraindicated?
No
YES
NO
Yes
3Wasanycertifying physician and/or acute or post-acute care facility documentationsubmitted?
NO
YES
Yes
No
3.2 (Criteria TWO)*Does the physician/facility documentation support that the patient has a normal inability to leave the home AND requires a considerable and taxing effort to leave the home?
NO
YES
Yes
No
3.1bIs the HHA info signed/dated by the certifying physician ?
NO
YES
Yes
No
3.1aDo the HHA medical records or plan of care satisfy the homebound criteria ONE requirements?
NO
YES
Yes
No
3.2bIs the HHA info signed/dated by the certifying physician ?
NO
YES
Yes
No
3.2cIs the HHA info corroborated by the certifying physician and/or acute or post-acute care facility documentation?
NO
YES
Yes
No
3.1cIs the HHA info corroborated by the certifying physician and/or acute or post-acute care facility documentation?
YES
NO
Yes
No
3.2aDo the HHA medical records or plan of care satisfy the homebound criteria TWO requirements?
NO
YES
Yes
No
Note Deny/ Non-Affirm reason (continue to step4)
Note Deny/ Non-Affirm reason (continue to step4)
Step 3 Homebound Requirement
.
.
Skilled Need RequirementIS MET.Proceed Step 5(Certification)
Yes
*Skilled need maybe substantiated through an examination of all submitted medical record documentation from the certifying physician, acute/post-acute care facility, and/or HHA (see below). The synthesis of progress notes, diagnostic findings, medications, nursing notes, etc., help to create a longitudinal clinical picture of the patient’s health status.
No
4.1aDo the HHA medical records or plan of care support thethe need for skilled services?
Yes
YES
NO
4.1bIs the HHA medical record or plan of care signed/dated by the physician?
No
Yes
YES
NO
No
Yes
4.1Is skilledneed(skillednursing care, PT, SLP, orOT) supported by the certifying physician, acute care facility, or post-acute care facility documentation?
YES
NO
Yes
No
4Wasanycertifying physician and/or acute or post-acute care facility documentationsubmitted?
YES
NO
No
4.1cIs the HHA medical record or plan of care corroborated by the certifying physician and/or acute or post-acute care facility documentation?
YES
NO
Yes
Note Deny/ Non-Affirm reason (continue to step5)
Step4 (Need for Skilled Care Requirement)
Yes
* A certification statement may appear in a progress note, plan or care, or any other part of thepatient's medical record. It may be on any form and in any format.** "skilled care" means skilled nursing care, PT, SLP, or a continuing need OTafterthe need for skilled nursing, PT or SLP have ceased.
.
.
All RequirementsARE MET.Mark the case AFFIRMED or PAYABLE
Yes
No
5Is acertificationstatement(s)*present?
YES
NO
No
Yes
5.1Does thephysician certify that the patientrequiresskilled care**?
YES
NO
No
5.2Does the physician certify that the patient ishomebound?
Yes
YES
NO
Yes
No
5.3Does the physician certify that a POC has been established by a physician who does not have a financial relationship with the HHA?
YES
NO
5.4Doesthe physician certify that the patient is under the care of a physician?
No
Yes
YES
NO
No
5.5bDoes the physician certify that the patient had a face to face encounter and did the physician document the date of the encounter?
Yes
YES
NO
5.5aDid the certifying physician conduct and sign the face to face encounter note provided?
No
YES
NO
Yes
Step5 (Certification Requirement)

0

Embed

Share

Upload

Make amazing presentation for free
Home-Health-Review-Tool-08-30-17