Medicare will allow for subsequent nursing facility care that monitor and evaluate residents at least once every 30 days for the first 90 days after admission and at least once every 60 days thereafter. The doctor’s note indicated that the beneficiary was evaluated for a chronic medical condition. The documentation submitted did not support the need for weekly evaluation and management; there was no indication of any new significant medical issues that would necessitate the increased frequency of the service. There was no indication of symptoms or physical findings that documented the medical necessity for a repeat examination. The visit was included in the procedure (17250- chemical cauterization of granulation tissue) allowance performed on the same day. The beneficiary was a 77 year old woman who had 3 …show more content…
The wounds that were located in the left sacrum and left hip had been present for more than 41 days and had serous exudate. The wound in the right hip had been present for more than 35 days and also had serous exudate. The provider cauterized the wound in the left sacrum after administering a local anesthetic and applied a special dressing to all 3 wounds. The plan was to follow-up “within 7 days.” The only documentation submitted was the “Wound Care Specialist Evaluation” for the date of service (07/22/2014) and there was no information of the initial assessment or subsequent visits. It was not documented when was the last time the beneficiary was evaluated, prior to the date of service in question. The QIC’s letter stated that Medicare will allow for subsequent nursing facility care that monitor and evaluate residents at least once every 30 days for the first 90 days after admission and at least once every 60 days thereafter. However, the payment history was not provided in order to determine when the previous service for the same issue was billed and
The overall process of discharging a patient from a hospital and the transition back home or to a care facility are critical advancements in the overall course of both acute and long-term care. It is important that the hospitals releasing these patients have ensured the proper overall course of care from beginning to end. The lack of consistency with both the discharge process and the quality of discharge planning has led to many avoidable readmissions. To reduce the amount of hospital readmissions, it is imperative that hospitals recognize the need for focused patient care and that programs are being implemented to assist in the care transition.
The extremity was prepped and draped in the usual fashion. Extremity exsanguinated, tunicate inflated. No equinus was present. Métier incision made from the tip of the fibula to the base of the fourth metatarsal. Extensor digitorum brevis and fat pad were elevated off the inferior peroneal retinaculum.
Client outcome: have surgical area that show evidence of healing no redness, draining, or immobility _______________________________________________________
This service was provided during the postoperative period for a previous related procedure conducted by the same surgeon.
The patient’s vital signs have stabilized, with HR in the 70s, BP is in the 120s/60s, regular RR and 37.6o Celsius temperature. Graft site wound bed is pink with tissue granulation noted. The learner is expected to prepare the patient for discharge. This SCE prepares the learner for the following items of the NCLEX-RN test format:
LeadingAge Texas is working with policy makers to pass the Nursing Home Quality Rate Enhancement health policy. Some of the issues addressed in the meeting regarding quality care will be addressed in this paper. How the NHQRE policy will impact the advanced nursing practice and the delivery of health care. NHQRE is a needed health policy that will increase our quality care.
Before the head-to-toe examination, a health history was obtained from the patient, in which a detailed
A prior review dated 12/01/2017 indicated that the claimant was approved for 12 visits of physical
Blair provided care for 87 to 90 residents daily. As a small home with limited financial resources, Blair had limited numbers of register nurses to follow residents on a one to one basis to catch any symptom 100% preventing readmission. Based on the database created, the database can analyze the risk of readmissions for chronic diseases using indicators such as resident age, diagnosis, and discharge status. The objectives of the project are the focus on the identification of indicators
The purpose of this field visit was to determine the Insured’s current medical status and any changes in his
The ratings provided in the article are for 2,463 of the United States acute-care or critical care type hospitals and the focus is Medicare type in-patient services, and implies that the same care received by other patients not insured by Medicare at these hospitals. The ratings are
The doctor, having gone through all of her reports including the most recent on 08/21/17, indicated that the claimant was approved for physiological testing which she thought had been done at the Helen Hayes Hospital but she had not yet seen the report.
Nearly 20% of Medicare beneficiaries discharged from hospitals are rehospitalized within 30 days, and 34% are rehospitalized within 90 days. For patients with conditions like CHF, the rate of readmission within 30 days reaches 25%. The estimated cost for unplanned rehospitalizations in 2004 was $17.4 billion. The Centers for Medicare and Medicaid Services penalizes hospitals for high rates of readmission within 30 days of discharge for patients with CHF, MI, and pneumonia.
42 Code of Federal Regulations (42CFR 482.23(b) requires hospitals certified to participate in Medicare to "have adequate numbers of licensed registered nurses, licensed practical (vocational) nurses, and other personnel to provide nursing care to all patients as needed". With such nebulous language and the continued failure of Congress to enact a quality nursing care staffing act to date, it is left to the states to ensure that staffing