Check out guides to nursing, rehab reports

Brenda A. Trask, RN, MSN, a site visitor for the Community Health Accreditation Program (CHAP) in New York, offers these guidelines for developing reports for a home care agency’s managed care specialist to use when dealing with managed care organizations (MCOs):

• Nursing Report for the Managed Care Specialist (MCS)

A. Initial and subsequent contacts with the MCS will be verbal reports. On occasion, reports may require a faxed copy of the nursing note to the insurance company. If required, the MCS will notify the case manager.

The following information is needed in the verbal report:

1. Last and first name and spelling, along with patient ID.

2. Specific number of visits for the next two-week period.

3. The clinical assessment, to include all vital signs, blood glucose readings, leg/abdominal measurements if applicable, and knowledge deficits.

4. Wound care descriptions to include:

    a. measurements, L x W x D with undermining (if applicable), depth, and location of undermining
    b. color of wound
    c. drainage color and amount
    d. location(s) of wound; if multiple wounds, be consistent with location and descriptions with each report

5. Wound care procedure.

6. Is a patient caregiver available to be taught and willing to assume responsibility for the wound care?

7. Will an ET (enterostomal therapist) nurse evaluate and suggest alternative procedures?

8. Homebound status.

9. Last or next physician appointment date.

10. If the purpose of the visit is to draw labs, report the results of the lab draw and any medication changes affected by the lab results.

11. If a home health aide is providing service, is that service to continue and why? What is the frequency of the visits for the next two weeks?

12. Will a nutritionist be utilized?

B. Reviews should be phoned to the MCS two days before the present authorization period expires.

C. If the total number of visits approved is not used within the allotted period, call the MCS to have the authorization period extended. Include the number of visits used versus the number authorized for that period with your request.

D. Notify the MCS with date of discharge and total number of visits used.

E. If a service is added, please call the MCS to confirm the benefit and obtain authorization. Give the reason for the need for the added service.

Rehab Report for the Managed Care Specialist

A. Initial contact with the team MCS after patient evaluation is completed requires a fax of the evaluation, using the correctly completed cover sheet. A verbal "heads up" voice mail should be left for the MCS; include any extenuating circumstances.

Subsequent requests are to include the following in a verbal report:

1. Last and first name, spelling, and patient ID number.

2. Specific number of visits for the next two-week period.

3. Present distance the patient can ambulate with/without an assistive device.

4. Present muscle strength in affected area(s).

5. Present range of motion in affected area(s).

6. Steps inside/outside of the house, presence of hand rails.

7. Goals over the next two weeks.

8. Homebound status.

9. Last or next physician appointment time.

10. If a home health aide is providing services, is that service to continue and why? What is the frequency of visits?

B. Reviews should be phoned to the MCS two days before the present authorization period expires.

C. If the total number of visits approved is not used within the allotted period, call the MCS to have the authorization period extended. Be sure and include the number of visits used vs. the number authorized for that period with your request.

D. Notify the MCS with date of discharge and total number of visits used.

E. If a service is added, please call the MCS to confirm the benefit and obtain authorization. Give the reason for the need for the added service.

Sources

Eileen L. Dohmann, MBA, RNC, Executive Director, Inova VNA Home Health, 8003 Forbes Place, Springfield, VA 22151. Telehone: (703) 321-6000.

Brenda A. Trask, RN, MSN, Site Visitor, Community Health Accreditation Program Inc., 350 Hudson St., New York, NY 10014. Telephone: (800) 669-1656.