DOCSLIB.ORG

Home Health Services Handbook

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Home Health Services Handbook HomeHome HealthHealth ServicesServices ARCHIVAL USE ONLY Refer to the Online Handbook for current policy DIVISION OF HEALTH CARE FINANCING WISCONSIN MEDICAID AND BADGERCARE PROVIDER SERVICES 6406 BRIDGE ROAD MADISON WI 53784 Jim Doyle Governor Telephone: 800-947-9627 State of Wisconsin 608-221-9883 Helene Nelson dhfs.wisconsin.gov/medicaid Secretary Department of Health and Family Services dhfs.wisconsin.gov/badgercare M E M O R A N D U M DATE: January 9, 2006 TO: Wisconsin Medicaid Home Health Agencies, HMOs, and other Managed Care Organizations FROM: Mark B. Moody, Administrator Division of Health Care Financing SUBJECT: Introducing the Wisconsin Medicaid Home Health Services Handbook The Division of Health Care Financing (DHCF) is pleased to provide you with a copy of the Home Health Services Handbook. This handbook is a guide to Wisconsin Medicaid for all Medicaid-certified home health agencies. Providers should maintain and refer to this handbook in conjunction with the All- Provider Handbook. This handbook incorporates current Wisconsin Medicaid policies related to home health agencies into a single reference source. TheARCHIVAL handbook completely replaces USE the Wisconsin ONLY Medical Assistance Program Provider Handbook, Part L, Divisions I and II. The handbook also replaces the following service-specific Wisconsin MedicaidRefer and BadgerCare to theUpdates: Online Handbook ! August 2005 Update (2005-57), Wisconsin Medicaid Issues Prior Authorization Home Care Attachment for Home Healthfor and current Private Duty Nursing policy Services. ! June 2004 Update (2004-48), Wisconsin Medicaid Covers Pneumococcal Vaccinations by Home Health Agencies in Addition to Influenza Vaccine. ! February 2004 Update (2004-08), Submitting claims with start-of-shift modifiers for home care services. ! August 2003 Update (2003-83), Changes to local codes, paper claims, and prior authorization for home health services, including private duty nursing and respiratory care services, as a result of HIPAA. ! June 2003 Update (2003-33), Discontinued home health procedure codes for private duty nursing. ! September 2000 Update (2000-33), Home care coverage determination software for Windows. ! April 1999 Update (99-13), Wisconsin Medicaid revises private duty nursing prior authorization guideline. ! May 1998 Update (98-15), Prior Authorization Request Charges for Home Health and Personal Care Agencies. ! July 1996 Update (96-27), Home Health Services: Reimbursement and Recipient Information Confidentiality. ! June 1996 Update (96-20), Flu Vaccinations. ! November 1995 Update (95-49), Home Health Reimbursement Limits and Other Changes. ! October 1995 Update (95-36), Home Health Changes for Medication Management. ! June 1995 Update (95-20), PRN Visits — Changes in Prior Authorization Procedures and Guidelines. Wisconsin.gov This handbook does not replace the all-provider publications, the Wisconsin Administrative Code or Wisconsin Statutes. Subsequent changes to policies affecting home health agencies will be published first in Updates and later in Home Health Services Handbook revisions. Additional Copies of Publications The Wisconsin Medicaid Web site, dhfs.wisconsin.gov/medicaid/, contains additional information for home health agencies, all Updates and electronic versions of the Home Health Services Handbook and the All-Provider Handbook. Providers who have questions about the information in this handbook may call Provider Services at (800) 947-9627 or (608) 221-9883. The DHFS would like to thank representatives from the Home Care Advisory Committee for reviewing this handbook. ARCHIVAL USE ONLY Refer to the Online Handbook for current policy CContacting Wisconsin Medicaid Web Site dhfs.wisconsin.gov/ The Web site contains information for providers and recipients about the Available 24 hours a day, seven days a week following: • Program requirements. • Maximum allowable fee schedules. • Publications. • Professional relations representatives. • Forms. • Certification packets. Automated Voice Response System (800) 947-3544 (608) 221-4247 The Automated Voice Response system provides computerized voice Available 24 hours a day, seven days a week responses about the following: • Recipient eligibility. • Claim status. • Prior authorization (PA) status. • Checkwrite information. Provider Services (800) 947-9627 (608) 221-9883 Correspondents assist providers with questions about the following: Available: • Clarification of program ARCHIVAL• Resolving claim denials. USE ONLY8:30 a.m. - 4:30 p.m. (M, W-F) requirements. • Provider certification. 9:30 a.m. - 4:30 p.m. (T) • Recipient eligibility.Refer to the Online HandbookAvailable for pharmacy services: 8:30 a.m. - 6:00 p.m. (M, W-F) for current policy9:30 a.m. - 6:00 p.m. (T) Division of Health Care Financing (608) 221-9036 Electronic Data Interchange Helpdesk e-mail: [email protected] Correspondents assist providers with technical questions about the following: Available 8:30 a.m. - 4:30 p.m. (M-F) • Electronic transactions. • Provider Electronic Solutions • Companion documents. software. Web Prior Authorization Technical Helpdesk (608) 221-9730 Correspondents assist providers with Web PA-related technical questions Available 8:30 a.m. - 4:30 p.m. (M-F) about the following: • User registration. • Submission process. • Passwords. Recipient Services (800) 362-3002 (608) 221-5720 Correspondents assist recipients, or persons calling on behalf of recipients, Available 7:30 a.m. - 5:00 p.m. (M-F) with questions about the following: • Recipient eligibility. • Finding Medicaid-certified providers. • General Medicaid information. • Resolving recipient concerns. TTable of Contents Preface ........................................................................................................................................ 7 Provider Information ..................................................................................................................... 9 Scope of Services .................................................................................................................... 9 Wisconsin Medicaid Certification Requirements ........................................................................... 9 Provider Certification for Personal Care Services ................................................................. 10 Provider Certification for Private Duty Nursing for Ventilator-Dependent Recipients ................ 10 Recipient Eligibility for Wisconsin Medicaid ................................................................................. 10 Limited Benefit Categories................................................................................................. 10 Copayment ........................................................................................................................... 10 Universal Precautions ............................................................................................................. 10 Written Statement of Recipient Rights ..................................................................................... 11 Distribution of Private Duty Nursing Information....................................................................... 11 Discharge of Recipients .......................................................................................................... 11 Availability of Records ............................................................................................................ 12 Wisconsin Medicaid Review ............................................................................................... 12 Termination of a Provider’s Certification ................................................................................... 12 Covered Services and Related Limitations ..................................................................................... 13 Place of Residence.............................................................................................................ARCHIVAL USE ONLY .... 13 Home Health Skilled Nursing Services ...................................................................................... 13 RecipientRefer Eligibility for to Home the Health OnlineSkilled Nursing ServHandbookices ................................................. 13 Hours of Care That Qualify as Home Health Skilled Nursing Services .............................. 14 Place of Service ..........................................................................................................for current policy 14 Home Health Skilled Nursing Visits...................................................................................... 14 Skilled Nursing Services ..................................................................................................... 14 Examples of Circumstances in Which Skilled Nursing May Be Required ............................ 14 Supervision ................................................................................................................. 15 Private Duty Nursing Services ................................................................................................. 15 Recipient Eligibility for Private Duty Nursing Services ............................................................ 15 Hours of Care That Qualify as Private Duty Nursing Services ......................................... 15 Place of Service for Private Duty Nursing Recipients ...................................................... 16 Ventilator-Dependent Recipients ..................................................................................
Load more

Recommended publications
  • Nursing Specialization in the UAE
    Nursing Specialization in the UAE Specialization Committee Prepared by : Michelle Machon, RN, MSN Presented by: Aysha Al Mehri, RN Nursing Specialization Specialization refers to “the acquisition of a level of knowledge and skill in a particular area of nursing/ patient population which is greater than that acquired during the course of basic nursing education” (ICN, 2009) Levels of Specialty Description Education Qualification A nurse with experience in a certain area of No formal RN nursing who is recognized by the employer or education licensing authority as “specialized” in the field. Specialty specific certificate short courses e.g. one month RN wound care course Specialty nurses without general RN training (e.g. 3 year “direct RN pediatrics, psychiatry, etc.) entry” degree Post RN graduate specialty programs focusing on a 12-18 month post- Specialty RN patient population (e.g. peds, critical care, etc.) graduate diploma Specialized in a specific patient Masters level Specialty RN or population/disease process (e.g. Cardiology or program Advanced Neurosurgery Clinical Nurse Specialist) or in a Practice RN functional field of nursing (quality, education etc) “Advanced practice” nurse training resulting in Masters or PhD Advanced autonomous practitioners (Nurse level Practice RN Practitioner/Nurse Anesthetist). Possible Specialties worldwide 200 + including: Hyperbaric nursing Perioperative nursing Immunology and allergy nursing Private duty nursing Ambulatory care nursing Intravenous therapy nursing Psychiatric or mental health nursing
    [Show full text]
  • Preferred Home Health Manual
    PREFERRED HOME HEALTH PROVIDER M A NUA L PRV20455-2102 Table of Contents Home Health Benefits ................................................................................................................................. 3 Introduction ....................................................................................................................................... 3 Filing a Home Health Claim ................................................................................................. 3 Conditions of Coverage for All Contracts ............................................................................. 3 Reimbursement ................................................................................................................... 3 Contract Exclusions ............................................................................................................ 3 Physical Therapy, Occupational Therapy and Speech Therapy ........................................... 4 Home Infusion Services ...................................................................................................... 4 Filing Home Health Drug Charges Electronically .................................................................. 4 Drugs Administered Outside the Patient’s Home................................................................. 5 Compound Drugs ............................................................................................................... 5 Factor Drugs ......................................................................................................................
    [Show full text]
  • Optimizing the Role of Nursing in Home Health
    Optimizing the Role of Nursing in Home Health May 30, 2013 This document has been prepared by CNA to provide information and to support CNA in the pursuit of its mission, vision and goals. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, or transcribed, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission of the publisher. © Canadian Nurses Association 50 Driveway Ottawa, ON K2P 1E2 Tel.: 613-237-2133 or 1-800-361-8404 Fax: 613-237-3520 Website: cna-aiic.ca ISBN 978-1-55119-403-5 05 2013 TABLE OF CONTENTS Key Messages ....................................................................................................................... 1 Executive Summary ............................................................................................................... 2 Overview ............................................................................................................................... 7 Approach ............................................................................................................................... 7 Background............................................................................................................................ 8 Home Care in Canada ...................................................................................................... 8 Canadian Population ........................................................................................................ 9 Current
    [Show full text]
  • Home Health Care – Commercial Coverage Determination Guideline
    UnitedHealthcare® Commercial Coverage Determination Guideline Home Health Care Guideline Number: CDG.022.18 Effective Date: August 1, 2021 Instructions for Use Table of Contents Page Related Commercial Policies Coverage Rationale ....................................................................... 1 • Home Hemodialysis Documentation Requirements ...................................................... 2 • Private Duty Nursing (PDN) Services Definitions ...................................................................................... 3 • Skilled Care and Custodial Care Services Applicable Codes .......................................................................... 3 References ................................................................................... 12 Community Plan Policy Guideline History/Revision Information ..................................... 12 • Home Health Care Instructions for Use ..................................................................... 12 Medicare Advantage Coverage Summary • Home Health Services and Home Health Visits Coverage Rationale Indications for Coverage The services being requested must meet all of the following criteria: A written treatment plan must be submitted with the request for specific services and supplies. Periodic review of the written treatment plan may be required for continued Skilled Care needs and progress toward goals; and Be ordered and directed by a treating practitioner or specialist (M.D., D.O., P.A. or N.P); and The care must be delivered or supervised by a licensed
    [Show full text]
  • Outpatient Case Management for Adults with Medical Illness and Complex Care Needs Comparative Effectiveness Review Number 99
    Comparative Effectiveness Review Number 99 Outpatient Case Management for Adults With Medical Illness and Complex Care Needs Comparative Effectiveness Review Number 99 Outpatient Case Management for Adults With Medical Illness and Complex Care Needs Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. 290-2007-10057-I Prepared by: Oregon Evidence-based Practice Center Portland, OR Investigators: David H. Hickam, M.D., M.P.H. Jessica W. Weiss, M.D., M.C.R. Jeanne-Marie Guise, M.D., M.P.H. David Buckley, M.D., M.P.H. Makalapua Motu'apuaka, B.S. Elaine Graham, M.L.S. Ngoc Wasson, M.P.H. Somnath Saha, M.D., M.P.H. ARHQ Publication No. 13-EHC031-EF January 2013 This report is based on research conducted by the Oregon Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10057-I). The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others— make well informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment.
    [Show full text]
  • Center for Home Care Policy and Research
    MASTER PROJECT LIST 1995-PRESENT Projects on improving the quality, cost-effectiveness, and outcomes of home care services Doyle: Perspectives of Patient, Caregiver and Healthcare Provider on Care Management and Shared Decision Making among Home Hospice Patients with Heart Failure Building on findings from on earlier Doyle Fund sponsored pilot study, this project explores the perspectives of patients, caregivers and healthcare providers who are caring for HF patients enrolled in the Cardiac Home Hospice care program. Sponsor: Eugenie and Joseph Doyle Research Partnership Fund of the VNSNY Dates: 09/01/2018 – 08/31/2019 P.I.: Masterson Creber, Ruth, PhD, MSc, RN & Baik, Dawon, PhD VNSNY: Russell, David, PhD Center for Improving Palliative Care for Vulnerable Adults with MCC (CIPC) The Center for Improving Palliative Care in Vulnerable Adults with MCC (CIPC) aims to provide expert guidance to nurse scientists in becoming leaders of interdisciplinary research teams that generate knowledge to inform how best to provide vulnerable adults with multiple chronic conditions with palliative that care is consistent with their personal preferences and reduces burdensome treatments and transitions. Sponsor: National Institute on Nursing Research (Subcontract w/ Columbia University) Dates: 08/08/18 – 05/31/23 P.I.: Stone, Patricia, PhD & Shang, Jingjing, PhD VNSNY P.I.: Topaz, Max, PhD Doyle: Provider insight on identification and management of urinary incontinence in home hospice This project involves utilizing structured interviews with nurses to learn how hospice nurses identify and manage urinary incontinence in home hospice patients. Sponsor: Eugenie and Joseph Doyle Research Partnership Fund of the VNSNY Dates: 07/15/2018 – 07/14/2019 P.I.: Chughtai, Bilal, M.D.
    [Show full text]
  • Medicare Home Health 101
    Kansas Home Care & Hospice Association 2021 Webinar Series Medicare Home Health 101 Dates and Times Program Objectives On-Demand Recordings Medicare Home Health is a critical service to assist and support our older population to recover from illnesses, injuries, and learn how to safely manage chronic diseases while staying in their home environment. Understanding critical factors to ensure the success of an organization offering this service will lead to healthy communities and long term Location partnerships with patients, families, and other health care providers across the continuum. Clinical processes that lead to excellence will be Your Office explored along with key regulatory criteria that must be followed and maintained will be the focus of this workshop. Registration Fees Part 1—The Framework for Home Health Services 75 minutes KHCHA Members ∗ — $110/agency Describe the history of home health nursing in the U.S. ∗ Identify the key regulations and guidelines as provided in the Non-Members Conditions of Participation and Kansas State Licensure for Home — $220/agency Health. ∗ Relay the importance of other regulatory bodies to Medicare Home Health. Target Audience Part 2—The Key to Medicare Home Health: The Home Visit RN’s, PT’s, OT’s, and SLP’s who 75 minutes are new to the Home Health ∗ industry Outline the “pre-visit” work plan. ∗ Demonstrate the key aspects of a Home Health Visit. ∗ Describe the critical components of interaction with each patient to ensure a successful integration into the home. Materials Part 3—Ensuring Quality and Survey Readiness Handouts will be provided with 75 minutes recording links. ∗ Describe the key clinical criteria used to evaluate quality.
    [Show full text]
  • BASIC STATISTICS ABOUT HOME CARE Updated 2008
    BASIC STATISTICS ABOUT HOME CARE Updated 2008 Prepared by: The National Association for Home Care & Hospice 228 Seventh Street, SE • Washington, DC 20003 202.547.7424 • http://www.nahc.org • E-mail: [email protected] Home care is a diverse and dynamic service Services were then extended to certain industry that began in US in the 1880’s. disabled Americans in 1973. Between 1967 Approximately 7.6 million individuals currently and 1985, Medicare-certified agencies grew receive care from 83,000 providers because of more than three-fold (1,753 to 5,983); however, acute illness, long-term health conditions, in the mid-1980s, Medicare-certified home permanent disability, or terminal illness.1 In health care agencies reached a plateau 2007, annual expenditures for home health (approximately 5,900) due to Medicare care were projected to be $57.6 billion.2 administrative burden and unreliable payments. This led to a 1987 lawsuit brought against the HOME CARE PROVIDERS then-Health Care Financing Administration (HCFA) by US Representatives Harley “Home care organizations” include home health Staggers (D-WV) and Claude Pepper (D-FL), care agencies, home care aide organization, consumer groups, and the National Association and hospices. Some of these organizations are for Home Care (NAHC). The successful lawsuit Medicare certified, which allows providers to gave NAHC the opportunity to participate in bill Medicare for reimbursement. Agencies that rewriting Medicare coverage policies, which are not Medicare certified cannot be significantly increased Medicare’s annual home reimbursed through Medicare. care outlays, and the number of agencies rose to over 10,000. Prior to clarifications in Medicare-certified Agencies coverage, public health agencies dominated the ranks of certified entities.
    [Show full text]
  • Building Standard-Based Nursing Information Systems
    Building Standard-Based Nursing Information Systems Pan American Health Organization World Health Organization Division of Health Systems and Services Development Essential Drugs and Technology Organization and Management of Health Systems and Services Human Resource Development December 2000 PAHO Library Cataloguing in Publication Data Pan American Health Organization. Building Standard-Based Nursing Information Systems. Washington, D.C. : PAHO, © 2000. 141 p. ISBN 92 75 12364 0 I. Title. 1. INFORMATION SYSTEMS. 2. NURSING. 3. NURSING PRACTICE CLASSIFICATIONS. 4. QUALITY OF HEALTHCARE. 5. MANUALS NLM W26.55.I4.p187 2001 ISBN 92 75 12364 0 The Pan American Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Applications and inquiries should be addressed to the Publications Program, Pan American Health Organization, Washington, D.C., which will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. © Pan American Health Organization, 2000 Publications of the Pan American Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the Pan American Health Organization concerning the legal status of any country, territory, city, or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the Pan American Health Organization in preference to others of a similar nature that are not mentioned.
    [Show full text]
  • Draft Reference Empirical Work Country
    Supporting Experienced Hospital Nurses to Move into Community Matron Roles Vari Drennan, Claire Goodman and Stephen Leyshon The Primary Care Nursing Research Unit Report of a study to examine the key knowledge and support required by nurses, experienced in the management of patients with long term conditions, to work in primary care contexts in undertaking community matron roles. Commissioned by the Department of Health (England) 2005 The Primary Care Nursing Research Unit: an academic, NHS research and service collaboration Acknowledgements This study was funded through the Access to Primary Care Programme, Department of Health England. The views expressed in this report are those of authors and not necessarily those of the Department of Health or the study expert advisory group. We are grateful to all the participants from the NHS and Higher Education Institutes across England for their help in completing this study. In particular, we thank staff from the following PCTs: Camden, Croydon, Lewisham, South Gloucestershire and the many PCTs associated with Kings College London, Christchurch College Canterbury, New Durham College, Plymouth University, and Leeds University. We would also like to thank the expert advisory group: Sarah Andrews Director of Nursing, Learning and Development, Camden PCT Gillian Black Director of Nursing, Quality & Professional Development, Lambeth PCT Sandra Betterton Director of Nursing, Norfolk, Suffolk & Cambridgeshire StHA Sue Buttfield Assistant Director of Nursing, Chiltern and South Bucks Primary Care Trust
    [Show full text]
  • Patient Documentation in Home Health Nursing in Norway - a Study of Attitudes Among Professionals
    Patient Documentation in Home Health Nursing in Norway - A Study of Attitudes Among Professionals 1 2,3 Jorunn Bjerkan , Rose Mari Olsen 1 Nord University, Levanger, Norway 2 Nord University, Namsos, Norway 3 Centre of Care Research Mid-Norway, Namsos, Norway Abstract. Introduction: Professionals in home health nursing mainly work alone in patients’ homes. This makes documentation from the electronic patient record crucial for carrying out proper care. The aim of this study was to elaborate on knowledge of home health nursing professionals’ attitudes towards electronic nursing documentation, and to investigate whether attitudes towards documentation and its performance differ with professionals’ education level and working experiences. Methods: A sample of 161 home health nursing employees in Mid-Norway answered a questionnaire including statements about experiences of nursing documentation and its use. Data was analysed by descriptive statistics and bivariate analysis in SPSS. Results: Of the sample, 77 respondents had higher education (HE), and 84 had lower education (LE). In total, 46 had less than 4 years’ experience at the workplace, and 115 had 4 years or more. The results showed an overall positive attitude towards documentation among the employees. However, HEs tended to have less positive attitudes towards nursing documentation than LEs. In addition, LEs more often gave neutral responses to the statements than HEs. Statistically significant differences were found in three of 11 statements: The HEs disagreed most with the statements that documentation makes it easier to find the nursing interventions planned for the patient (p=0.03), increases the quality of reporting to other caregivers (p=0.003), and provides clarification concerning the implemented nursing interventions.
    [Show full text]
  • Professional Nursing Eportfolio
    Professional Nursing Portfolio RN to BSN Professional Portfolio Credit Worksheet Student: ________________________________ _____________ The submission of the Portfolio must include supporting documentation. Credits will be allocated following review by the student’s Program Director and the Associate Dean. 1. Professional Work Experience Possible Credits 0-6 Preliminary Review Credits Awarded _____ 1-2 years experience 1 credit _____ 3-4 years experience 2 credits _____ 5-6 years experience 3 credits _____ 7-8 years experience 4 credits _____ 9-10 years experience 5 credits _____ > 10 years experience 6 credits 2. CE Program Credits Possible Credits 0-4 Preliminary Review Credits Awarded _____ 15-30 CE hours 1 credit _____ 31-45 CE hours 2 credits _____ 46-60 CE hours 3 credits _____ >61 CE hours 4 credits 3. Certification in a Nursing Specialties American Nurses Credential Center Possible Preliminary Credits (ANCC) Certification: Credits 0-4 Review Awarded Ambulatory Care Nursing Cardiac Rehabilitation Nursing Cardiac Vascular Nursing Case Management Nursing College Health Nursing Community Health Nursing General Nursing Practice Gerontological Nursing High-Risk Perinatal Nursing Home Health Nursing Informatics Nursing Maternal-Child Nursing Medical-Surgical Nursing Nurse Executive Nursing Professional Development Pain Management Pediatric Nursing Perinatal Nursing Psychiatric & Mental Health Nursing School Nursing Critical Care Registered Nurse (CCRN): American Association Critical Care Nursing Diabetes Educators: National Certification
    [Show full text]