Hi, Jimmie, The joys of interpretation................. *smile* I'll explain how our agency interprets the criteria for homebound status, based upon the same documentation you copied for the group (which I appreciate!): The last paragraph from the HIM 11states: ".....However, occasional absences from the home for nonmedical purposes, e.g., an occasional trip to the barber, a walk around the block or a drive, would not necessitate a finding that the patient is not homebound if the absences are undertaken on an infrequent basis or are of relatively short duration and do not indicate that the patient has the capacity to obtain the health care provided outside rather than in the home." I believe the key phrase here is "capacity to obtain health care...outside...the home."
I will give examples here of some of the clients we felt we needed to discharge based upon our interpretation of homebound/non-homebound status. Boy -- I feel like I'm about to open up a can of worms, but hey, this is a great topic to discuss here! 1. A legally-blind client with macular degeneration who could independently take a bus to her doctor appointment and do a little grocery shopping before heading home. (She had been receiving home-based therapy following shoulder surgery). We discharged her to outpatient therapy after she took the bus twice in one week. 2. A client who'd had spinal surgery and was being treated for arm weakness who could walk around her block on a daily basis and be driven to doctor appointments and family events was discharged to outpatient therapy. 3. A client for whom we did a Start of Care, whom we then could not reach via phone or visits to the home because he was being driven around to various places by a friend. In these cases, we do our utmost to provide the client with resources for transportation if they do not have a reliable source. I will often have the medical social worker pay a visit to facilitate this. What I believe it may boil down to is that if the client can get out and go to outpatient therapy, we probably should discharge or not take on the case. Medicare may (and will) deny reimbursement if we can't justify true homebound status. Medicare combs cases for this type of situation. Susan Jimmie Arceneaux <[EMAIL PROTECTED]> wrote: Hey Susan, Your definition of the home bound criteria is not accurate. The homebound criteria allows for one to "be driven somewhere, like to a doctor's appointment." From the HIM 11(Basicaly the definition of homebound criteria from the bureaucrats themselves): "If the patient does in fact leave the home, the patient may nevertheless be considered homebound if the absences from the home are infrequent or for periods of relatively short duration, or are attributable to the need to receive health care treatment. Absences attributable to the need to receive health care treatment include, but are not limited to, attendance at adult day care centers to receive medical care, ongoing receipt of outpatient kidney dialysis, and the receipt of outpatient chemotherapy or radiation therapy. Any absence of an individual from the home attributable to the need to receive health care treatment, including regular absences for the purpose of participating in therapeutic, psychosocial, or medical treatment in an adult day-care program that is licensed or certified by a State, or accredited, to furnish adult day-care services in a State shall not disqualify an individual from being considered to be confined to his home." "Any other absence of an individual from the home shall not so disqualify an individual if the absence is of an infrequent or of relatively short duration. For purposes of the preceding sentence, any absence for the purpose of attending a religious service shall be deemed to be an absence of infrequent or short duration. It is expected that in most instances, absences from the home that occur will be for the purpose of receiving health care treatment. However, occasional absences from the home for nonmedical purposes, e.g., an occasional trip to the barber, a walk around the block or a drive, would not necessitate a finding that the patient is not homebound if the absences are undertaken on an infrequent basis or are of relatively short duration and do not indicate that the patient has the capacity to obtain the health care provided outside rather than in the home." Jimmie -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Spot_60 Sent: Thursday, April 14, 2005 9:23 PM To: [email protected] Subject: RE: [OTlist] Home Health Question Since she seems to be doing pretty well, I am wondering: What is qualifying her as "home-bound?" Does she use an assistive device to ambulate? Does she require assistance to leave the home? For instance, if she could safely and independently leave her home and be driven somewhere, like to the doctor's or to the store and not require assistance, she may not be truly homebound and Medicare is going to question why she's being seen by home health and then reimbursement becomes an issue. Just something to toss out there. Susan __________________________________________________ Do You Yahoo!? Tired of spam? Yahoo! Mail has the best spam protection around http://mail.yahoo.com -- Unsubscribe? [EMAIL PROTECTED] Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] Help? [EMAIL PROTECTED] *** NOTICE--The attached communication contains privileged and confidential information. If you are not the intended recipient, DO NOT read, copy, or disseminate this communication. Non-intended recipients are hereby placed on notice that any unauthorized disclosure, duplication, distribution, or taking of any action in reliance on the contents of these materials is expressly prohibited. If you have received this communication in error, please delete this information in its entirety and contact the Amedisys Privacy Hotline at 1-866-518-6684. Also, please immediately notify the sender via e-mail that you have received this communication in error. *** -- Unsubscribe? [EMAIL PROTECTED] Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] Help? [EMAIL PROTECTED] --------------------------------- Do you Yahoo!? Yahoo! Small Business - Try our new resources site! -- Unsubscribe? [EMAIL PROTECTED] Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] Help? [EMAIL PROTECTED]
