SUBUNIT OPERATIONAL PROCESSES AND ROLES

Transcription

1 INTAKE AND REFERRAL Takes referral if no nurse in office. Nurse will call back for orders. LPNs may take referrals. Obtain Medicare and Medicaid verifications. Obtains private insurance web verifications. Consults with supervisor regarding problems. Verify and check intake information entered, update as needed. Enter any information not entered. SUBUNIT OPERATIONAL PROCESSES AND ROLES Takes referrals and enters information into Horizon/HBS 201. Enter, generate, and assign evaluation visit. Verify third party insurance authorizations and requirements. Enter pertinent Home Care diagnoses obtained during intake. Ensure all referrals not admitted are being tracked and the admission and discharge detail tabs of Horizon are completed. For referrals not admitted, complete admission and discharge detail tabs. Ensures admissions/nonadmissions are appropriate. Monitors/Tracks 'Referrals Not Admitted' for problem resolution as needed. ABM monitors CM is completed appropriately. Intake and Referral_Page 1 of 14

2 ADMISSION, DISCHARGE, AND TRANSFER Checks and ensures all parts of the patient profile/customer maintenance are completed on admission and discharge. Performs admission. Completes visit documentation and all parts of the patient profile including the admission detail tab. On discharge, completes discharge information/discharge detail and the discharge summary. Completes the Transfer Notification Form (HBS 101) according to established process. Coordinates and communicates with the Supervisor to ensure all Transfer OASIS Reviews are completed on assigned caseload. Correct any identified Transfer OASIS assessments and documentation errors according to policy. SUBUNIT OPERATIONAL PROCESSES AND ROLES OASIS/CODING Performs admission review to consist of evaluation for needed changes to the Diagnosis and Severity Index, to include co morbidities, correct coding, and coding sequencing. An evaluation will be done for appropriate orders, referrals, utilization of all disciplines, correct responses to OASIS items. Consult with the Bureau Rehab Consultant and follow the Therapy Plan of Care Process as indicated. Review Mini OASIS (if applicable). Completion of the Initial OASIS Review Form and the OASIS Auditor will be utilized. Oversight to the admission and discharge process. Ensures Admission Detail and Discharge Detail tabs are completed correctly. Reviews all Initial OASIS Reviews for utilization and episode costs. Routes the Initial OASIS Review to the appropriate Nurse Care Coordinator. Conducts follow up to ensure all agreed upon corrections have been made to the OASIS. Follows up with Therapist on concerns regarding functional OASIS scoring, assessment findings, submission of documentation, rehab potential, therapy visits ordered, or other concerns as identified. (CONT...) Admission, Discharge, and Transfer_Page 2 of 14

3 ADMISSION, DISCHARGE, AND TRANSFER Checks diagnoses in the OASIS and updates diagnoses in CM as needed. SUBUNIT OPERATIONAL PROCESSES AND ROLES OASIS/CODING (... CONT) Will consult with the bureau Rehab Consultant, if needed, and follow up on any recommendations from the Rehab Consultant. Ensures the Transfer Notification Form (HBS 101) is completed and faxed according to established process. Review all Transfer OASIS for appropriate responses. Complete the Transfer OASIS Review Form and route to the appropriate Nurse Care Coordinator. Runs PPS Episode Detail Report for new admission if paper copy is needed. Checks and manages HHRG utilization using PPS report and HHRG cost calculator. Gives oversight for HHRG utilization. Makes sure appropriate referrals are made. Monitors cost and appropriateness of care utilizing PPS Episode Detail Report. Troubleshoot as needed. ABM monitors that CM is completed appropriately including bill sequence, admission detail tab, authorizations, and discharge detail tab. Admission, Discharge, and Transfer_Page 3 of 14

4 SUBUNIT OPERATIONAL PROCESSES AND ROLES PHYSICIAN ORDERS/CERTIFICATIONS/DOCUMENT TRACKING Enters paper documented orders. Creates certifications after 60 day assessment/fu OASIS are completed. Enters and completes orders when taken. Documents receipt of verbal order in record. Can create certifications as needed. DAILY: Batch print orders from previous work day and print certifications ready to be reviewed. MINIMUM 2 X WEEK: Mail/Deliver printed, signed orders to MD. Complete, as needed, and mail signed certs. Reviews and signs printed verbal order. Others can review and sign in the receipt of the VO is clearly documented in record. Review, sign, and complete certifications. Run expiring cert report monthly and distribute to Nurse Care Coordinators. Mark sent/mailed orders and certs 'mailed' in Document Manager. Utilizes Document Manager daily to check in returned certs and orders. Monitor expiring certifications to ensure comprehensive assessment and recertifications are completed per regs. Gives oversight. Physician Orders/Certifications/Document Tracking_Page 4 of 14

5 SUBUNIT OPERATIONAL PROCESSES AND ROLES PHYSICIAN ORDERS/CERTIFICATIONS/DOCUMENT TRACKING Utilizes the reports in Document Manager to track incomplete, not printed, and outstanding documents. Reviews the tracking reports to ensure completion and that all documents are printed and mailed timely. Reviews the Outstanding Orders report and assists the clerical staff, as needed, in obtaining orders and certs from the MD within 30 days of the order date. Oversight of the Document Tracking Process. Physician Orders/Certifications/Document Tracking_Page 5 of 14

6 MEDICATION MANAGEMENT Enters any new medications and updates medication for clinicans not using a laptop. Records, updates, and reviews patient medications. Addresses interactions. Performs medication regimen review each visit. SUBUNIT OPERATIONAL PROCESSES AND ROLES Oversight using 60 Day Medicare Episode Summary reviews. Medication Management_Page 6 of 14

7 SUBUNIT OPERATIONAL PROCESSES AND ROLES SCHEDULING Scheduling roles may vary between subnits. Therfore, processes are listed under a generic "Scheduler Role". SCHEDULER SUPERVISOR Generates service orders when entered. Check ungenerated service orders at the beginning of each work day and more often as needed. Assigns visits as they are generated. Checks and assigns open visits at the beginning of each work day. Maintains employee and patient schedules through the use of Interactive Scheduler. Prints employee schedules at least weekly and as needed and makes available to visiting staff. Performs or works closely with scheduler to ensure service visits are assigned and made according to treatment plan. Monitors Interactive Scheduler for appropriateness and for oversight to employee schedules. Tracks therapy visits to ensure visits are provided as ordered and reassessments are performed as required. Scheduling_Page 7 of 14

8 SUBUNIT OPERATIONAL PROCESSES AND ROLES OASIS COLLECTION/SUBMISSION/TRACKING Enter any 'paper' OASIS in Horizon. Extract and submit OASIS a minimum of one time a week. Completes OASIS per policy to make available for extraction. Oversight of completion, extraction, and submission process. Oversight to overall process. Prints Initial and Final Validation reports to verify successful submission. Make corrections until successdul submission. ABM monitors extraction, submission, and tracking process. Troubleshoots submission problems. Tracks OASIS submissions using the Horizon reports per policy. Maintains OASIS tracking reports and validation reports. OASIS Collection/Submission/Tracking_Page 8 of 14

9 PRE BILLING DAILY: Checks Encounter Forms against information in batches in Enter Services. Corrects batches as needed. DAILY: 'Assignment Completion' to check and complete services for visiting staff not using a laptop or telephony. DAILY: Verifies and generates services in Enter Services. DAILY: Troubleshoots error messages in Enter Services to have clean generation of services. Completes visit information and visit notes per policy. SUBUNIT OPERATIONAL PROCESSES AND ROLES Ensures supervisory visits are made per regs/policy. Ensures therapy reassessments were performed as required by regulation. Joint responsibility to do 60 Day Episode Review per outlined process. FOR FEE FOR SERVICE BILLING: Run Transaction Register, as needed, to check services to be billed by payor. Ensures all visits are completed. Ensures therapy visits and paperwork are submitted per policy. Provides oversight to Enter Services processes to ensure services are generated to billing in a timely manner. Pre Billing_Page 9 of 14

10 SUPPLY MANAGEMENT Orders routine and nonroutine medical supplies. Maintains non routine supply inventory. SUBUNIT OPERATIONAL PROCESSES AND ROLES Assures there is an MD order for all non routine supplies. Assures there is a payor for non routine supplies. Ensures appropriate supplies are on hand and are checked out per procedure. Ensures all non routine supplies are entered into Horizon. Provides oversight to supply process. Uses the Medical Supplies for HH Patients form (HBS 287) to enter all patient supplies into Horizon. Completes the Medical Supplies for HH Patients form (HBS 287) when obtaining non routine supplies. Supply Management_Page 10 of 14

11 SUBUNIT OPERATIONAL PROCESSES AND ROLES MEDICAL RECORDS MANAGEMENT Maintains medical records in a confidential manner according to policy. Provides oversight to maintenance of policy and procedure. Releases any medical records according to the Medical Records: Confidentiality Policy. Releases any medical records according to the Medical Records: Confidentiality Policy. Provides guidance and oversight in the event there is a release of medical information. Prepares discharged records and completes Destruction Notices according to the Medical Record: Retention and Destruction Policy. Medical Records Management_Page 11 of 14

12 COMMUNICATION PROCESSES AND ROLES SUBUNIT OPERATIONAL PROCESSES AND ROLES /OTHER VISITING STAFF LPN in office and all other visiting staff to participate in case conferences. Attends, participates, prepares, and documents case conferences on assigned case load. OASIS/CODING CASE CONFERENCES Attends. Holds and moderates formal group case conferences per written process. Attends and gives oversight to case conferences. See also: Management Processes and Roles Clinical/Quality Improvement Management Case Conference. Devlelops and presents eduction/staff development programs at Case Communication Processes and Roles_Page 12 of 14

13 SUBUNIT OPERATIONAL PROCESSES AND ROLES INITIAL OASIS/EPISODE/TRANSFER REVIEWS OASIS/CODING INITIAL OASIS REVIEWS Completes Initial OASIS Reviews in assigned area. Checks for OASIS consistency with clinical Adheres to the assessment, orders, established process for clinical findings, and Initial OASIS Reviews. notes. Uses OASIS Communicates and Auditor and determines collaborates with the HHRG, then routes Area Coding Initial OASIS Review to Coordinator to ensure Supervisor and copies Initial OASIS Reviews the HCD and Area are completed for case Manager. Utilizes load. Corrects any Therapy Process and identified OASIS reviews Therapy Miniassessments according OASIS, if applicable. to policy. Reviews Flag Communicates and Summaries on all followup and ROC OASIS collaborates with Nurse Care Coordinators to assessements before ensure all reviews for completing the area are completed documentation. timely. Provides written feedback to Nurse Care Coordinators on reviews. See Management Processes and Roles Clinical/Quality Improvement Management Initial OASIS Reviews. Initial OASIS/Episode/Transfer Reviews_Page 13 of 14

14 SUBUNIT OPERATIONAL PROCESSES AND ROLES INITIAL OASIS/EPISODE/TRANSFER REVIEWS OASIS/CODING EPISODE REVIEWS Prints the Episodic Equation Analysis Report weekly for Supervisor. Reviews Flag Summaries before completion of all Follow up and ROC OASIS documentation. TRANSFER REVIEWS See Management Processes and Roles Clinical/Quality Improvement Management Episode Reviews. Route/Notify Supervisor of the Transfer OASIS for review. Completes the Transfer Notification Form (HBS 101). Makes corrections as indicated. Signs the Transfer Review Form. See Management Processes and Roles Clinical/Quality Improvement Management Transfer Reviews. Initial OASIS/Episode/Transfer Reviews_Page 14 of 14