Frequently Asked Questions

1Does the agency need a Medical Director?
No. The agency may opt to have a Medical Advisor.
2Can the Medical Director sign the 485 and Face to Face?
The Medical Director can only sign the 485 and/or the Face to Face if the Medical Director is the patient’s certifying physician.
3On the 485 can you use visit ranges for frequencies?
No. Frequencies must be written week specific. Example: SN 1w5, 2w4. A set number of prn visits may be added. The reason why the prn visit would be made must be specifically indicated in the 485.
4Can you subcontract PT, OT, SLP and MSW services?
Yes. You must provide at least one direct service. Other services may be provided thru a contracted provider.
5Can you revise the goals on the 485 once it has been signed by the physician?
Yes. The goals may be revised by submitting an interim order to the physician.
6How do you handle a patient who has been re-certified more than 2 times but still requires services?
As long as the patient meets all the requirements for Medicare services and requires care, the agency must continue to service the patient until which time the patient does not qualify for services or the goals have been met.
7Can you teach more than 2-3 items on one visit?
Yes. When teaching is performed a patient response should be noted.
8Can a patient who is 10 years old have an OASIS completed?
Yes. The OASIS is a complete assessment tool that can be used for any patient population. If the OASIS is used for the Pediatric patient, an additional tool that contains Pediatric specific assessments should be included.
9Would leaving a copy of the 485 in the patient’s home be a HIPAA violation?
No.
10If the Director of Nursing is making a weekly visit to the patient and the patient is also receiving HHA services, can the RN weekly visit serve as the supervisory visit for the HHA? Does the HHA have to be present?
Yes. When the patient is receiving skilled services and HHA services, the supervisory visit must be completed at least every 2 weeks. The HHA does not have to be present. The RN must complete the supervisory section on the clinical note.
11If the patient has wound care ordered that include a prescription ointment is the agency responsible to provide the ointment?
No. The agency is not responsible to provide any prescription medications. The patient is responsible to obtain any prescriptions from a retail pharmacy.
12Can the HHA perform blood sugar checks?
No. This skill can only be performed by the RN or LPN.
13How often does the LPN need to be supervised? Can it be done by phone?
The RN performs a supervisory patient visit for the LPN every month. The RN makes the patient visit instead of the LPN. This visit cannot be done over the phone. Yearly the RN will make a joint visit with the LPN to complete the yearly competency and performance evaluation.
14How often does CHAP re-survey after the initial survey?
The typical re-survey cycle is every 3 years. CHAP may make unannounced surveys if a complaint is made or the agency has a significant event occur.
15Can I bill for start of care, resumption of care and discharge visits?
No. Under the Medicare PPS system you are paid a set amount based on the OASIS-C transmission. Adjustments to the total payment are made when the discharge OASIS is submitted. You do not bill for individual visits.
16When should the patient satisfaction surveys be completed?
It is recommended that the post admission survey is completed after the 2nd week of service. This survey may be done by phone. The discharge survey is given to the patient at the time of the last visit. A return envelope should be provided.
17Does the patient have to sign the OASIS or visit notes?
No. The patient is not required to sign. It is recommended that the patient sign the HHA notes.
18If you are not able to use the bathroom sink to perform hand washing, can you use gel?
Yes. Soap and water is always the preferred choice for hand hygiene, however gel is a better choice if the bathroom is not available. The kitchen sink should not be used.

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