Enhancing Documentation for Homebound Status
Understanding the Challenge
Clinicians often face challenges in ensuring defensible documentation that supports homebound status, particularly during auditing activities. The reliance on Electronic Medical Record (EMR) systems has become a common practice to meet the requirements for payment of services under the Medicare Part A Home Health benefit. However, merely using regulatory language, such as “considerable and taxing effort,” is insufficient to demonstrate that homebound status exists. This phrase is frequently cited when therapy services are provided yet does not adequately capture the specific circumstances of each patient.
Importance of Comprehensive Home Assessment
One area that is often underdeveloped in both the comprehensive assessment (admission) and therapy evaluation is the home assessment. An evidence-based approach to reducing the risk of falls includes a standardized assessment of the home environment. This is crucial, as a majority of falls occur within the home for the elderly community-dwelling population. Enhancing the home assessment component of any SOC visit and therapy evaluation can:
- Clarify homebound status.
- Support the need for skilled services.
- Assist with reduction of falls that can cause unwanted outcomes like rehospitalization.
- Resources for Documentation: Participants will receive instruction here to improve their documentation practices. This includes specific examples of appropriate language to use in clinical documentation, ensuring clarity and accuracy in representing a patient’s homebound status.
- Comprehensive Home Assessment Program: Introduction to a comprehensive home assessment program that is easy to use and readily available to clinicians. This program is designed to enhance the quality of home assessments conducted by therapists.
- Sample Home Assessment Tool: This sample home assessment tool will be provided as a template for completing thorough home assessments. This tool will assist clinicians in evaluating the home environment effectively and in identifying potential fall risks.
Clinically we need to include our long-term patients, for example Foley catheter management, in our homebound assessments and these should continue to be factored in for home health qualification. We have recently had a run of audits that have uncovered more than 20 straight cert periods without a new assessment of the homebound status and/or absence of any qualifying medical documentation from the patient’s primary provider. We feel the medical provider input should occur no less frequently than ever 3-4 months to update the code list and address any new medical problems that may have been updated or clarified over that span of time.
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