In-Take
Patient intake is the process through which healthcare organizations collect demographic, social and clinical data, consent forms, insurance, payments, and other key pieces of information from new and returning patients prior to their visit. The Intake Coordinator is responsible for the admission process for new patients by ensuring availability of reimbursement for services, identifying the clinical team to deliver care, and scheduling all patient visits within prescribed discipline and visit frequency requirements.
Eligibility And Benefits Verification:
Once the demographics are collected, the insurance verification team will verify the eligibility and benefits to see if the patient is having an active coverage and home care visits are covered as per the patient’s plan benefits. Insurance verification are done with the payers by calls/payer online accounts.
Disciplines & Services
Once the verification team confirms the patient’s eligibility and benefits information and after the required orders are collected by the intake team, the required home care disciplines for the patient are plotted with the respective
clinicians, clinical nurse, therapists, MSW, and Home Health Aide. The start of care is plotted as per the request from the patient.
Pre-Auth
The Authorizations team will request for a prior authorization, if required as per the payer specifics before the start of care. Authorizations are requested from the payer either a call, online requests, or through fax.
OASIS Review:
OASIS is a patient-specific standardized assessment tool used in the home health setting for patients insured through Medicare. An OASIS reviewer is typically a nurse- but could be another clinical specialty such as physical therapist. The main responsibility is to ensure accuracy on OASIS and remain compliant. OASIS assessment is used to monitor the quality of home health care to ensure that the needs of patients are properly met. It measures patient outcomes by tracking the health status of home health care patients over time. It is also useful in analysing health care processes and methods in the home health care field. There are six different types of OASIS:
- S0C & Resumption of care following inpatient facility stay
- Recertification within the last five days of each 60-day recertification period & Other follow-up during the home health episode of care
- Transfer to an inpatient facility
- Death at home
- Discharge from agency
Coding:
Coding team is responsible for uploading the primary and secondary diagnoses on the patient’s OASIS based on the diagnosis mentioned on the referral or signed MD documents and the reason for home bound care. Each diagnosis will be marked with onset/exacerbation date and the severity is marked based on the agency specifics.
Orders Management
Orders Management is the process of collecting the home care orders from the physicians which is required before billing a home health claim to the payers. The following home care orders are sent to the physician’s office for signature through fax/mail/courier. The physicians will manually sign each of the order and will return it back to the Agency. These orders are collected and will be required when there is a recovery audit performed by the payers. There are few electronic applications like Suture Sign for sending/receiving the signed orders. The following orders require a physician signature and date:
- Physician orders
- CMS 485’s
- Face-to-face encounters
- Post hospital orders
- SN visits
- SN discharge summaries
- Therapy evaluation notes/visits
- MSW evaluation
