THE HOME HEALTH PROFESSIONAL

TRUE FACTS

• Anyone can be a leader in the industry 
• Leadership is about possibilities-seeing opportunity and hope, where many believe this does not exist.
• Leaders have clear and focused visions, goals and objectives
• Effective leaders earn respect; they do not demand it by wielding power or using force. They admit their failures and mistake and strive to learn from them
• Leadership requires some element of risk taking which can sometimes be frightening or disorienting.
• Leadership requires self-knowledge and accountability, self-awareness, the ability to listen and compassion for others 

“A good leader inspires others to have confidence in him/her. A great leader inspires people to have confidence in themselves”


Anonymous

SOME “PRESCRIBED” NAMES ASSOCIATED WITH HOME HEALTH AGENCIES

Provider Agency

Therapy Agency

Place for the Sick

Non-Custodian

Out-Patient facility

Nursing Agency

Home Care

Medicare Company

Medicaid Company

Health Insurance

Rehab

PROPER DEFINITION

Home health agency (HHA) means a public or private agency or organization that offers home care services including skilled nursing services and at least one other therapeutic service in the residence of the client through physicians, nurses, therapists, social workers, and homemakers whom they recruit and supervise.

Home Health Operation and Administration goes far beyond just visiting and providing the necessary support and care for outpatients in their homes.

DISCOVERING OPPORTUNITIES AND POTENTIAL

The United States congress has continuously passed legislation to regulate the Healthcare industry with a focus on Social Security and Medicare. Regulations have brought about innovations to track fraud and abuse of tax payers’ dollars and this has opened opportunities for non-medical professionals to venture into healthcare. Some areas are as follows:

• Information Technology and Software Development
• Accounting and Book-Keeping
• Consultancy and Training Services
• Billing Services

Medical personnel like Registered Nurses and Physicians are continuously equipping themselves with business and management skills to enable them cope in this fast paced industry that is continuously audited by various government contractors hereby forcing business owners to focus on “paper work” more than administration of care.

As you start your journey in this new career path, some fundamental questions you would continue to ask..

• Why is the Doctor/Physician not familiar with the policies?
• Why is the nurse so focused on making visits and not profits?
• Why are you more bothered with the implication of the actions of the healthcare professionals in the dissemination of care?
• Why are the variances in your budget adversely outrageous?
• Why do you need to be involved with your heart and soul?

The questions you will continue to ask are numerous and the answers and solutions will only be received if you keep an open mind.

THE PROFESSIONAL YOU!

• Assume you know nothing for the first 6 months
• Mingle with home health professionals and administrators and not just Registered Nurses and Doctors
• Ensure you have a diary with you at all times, or make the best use of your smart phone
• Understand your agency policy as it affects your operations, it’s sometimes different from that of other agencies
• Don’t get involved in any form of training within the first 3 months of starting, observe and learn on the job so you do not get more confused than you already are
• Respect people you meet in the industry despite their qualification

 TIME MANAGEMENT

To be an effective leader in this industry, you need to use their time efficiently. This requires that you master the art of effective time management. A broad range of people or activities can make demands on your time, but they cannot control it.

You are responsible for managing your time!

How do you spend your time?

In managing your time, concentrate on results, not on being busy - Many people spend their days in a frenzy of activity, but achieve very little because they are not concentrating on the right things. 

       STEPS FOR IMPROVING YOUR ABILITY TO MANAGE YOUR TIME

Learn how to control the demands on your time:

a)    Create to-do lists – keep a diary or planner; be realistic about how much time it will take you to accomplish a task. Remember the 80:20 rule: 80% of results are achieved with only 20% of the effort

b)    Prioritize effectively – what makes your big list? Is it family, society, health and well being, wealth, career growth, intellectual growth or spiritual growth? Attach specific, action-oriented goals and tasks, with timelines to each of your priorities.

c)    Delegate, when possible

How to delegate:

·        Consider gradually increasing authority and responsibility.

·        Set clear, realistic goals for the task to be delegated.

·        Communicate the assignment clearly.

·        Give your support person complete information on organizational policy and procedure as it relates to the assignment.

·        Define the limits of responsibility as it relates to the assignment.

·        After the delegate thoroughly understands the limits of authority, allow him/her to go ahead.

·        Give the delegate the authority needed for carrying out the assignment, and inform others that s/he has this authority.

d)   Minimize interruptions

e)    Improve the effectiveness and efficiency of meetings

f)     Set limits 

g)    Learn to say No – you cannot be all things to all people

h)    Learn to multitask – you can often do multiple things at the same time e.g. answering phone calls and arranging client charts

i)     Create an efficient system of decision-making: Determine what is important after carefully considering the goals you set for yourself. Always look at the bigger picture, what task or activities do I need to undertake that will enable me meet deadlines? Do not waste time agonizing over spilled milk, like why did the DON did not submit her visit notes for billing? Instead focus on developing a system that would enable Nurses submit their visit logs on-time.
  
j)  Organize your environment –A messy working or living environment can take a significant amount of your time from a typical day. Investing 45 minutes of your day in cleaning and arranging your space can save you a significant amount of time and frustration. Create effective filing systems and remove anything from your immediate environment that you will not need to use or encounter for weeks or months

WORKING WITH OTHERS

Staff turnover in this industry is pretty high, some people work for a year and for some reason they believe they should be consultants J When selecting personnel to work on your team there are certain things you need to look out for:

High Skill/Low Will	High Skill/High Will
Low Skill/Low Will	Low Skill/High Will

 

Understanding this matrix enables you to sift through the number of individuals you will work with during the course of you career, enabling you to identify, motivate, and retain great potential who will support you in achieving your long-term goals.

Because team work is the key to success in this industry, you will need to have dependable and knowledgeable team mates.

 

SKILLED SERVICE DELIVERY

Medicaid covers all Medicare services but not all Services covered under Medicaid are covered by Medicare. While Medicaid covers custodial services (long-term care) and Skilled Services, Medicare covers only skilled services. Below is a table comparing the services of both Medicare and Medicaid:

Services	Medicare	Medicaid
Medical Supplies and Equipment	Yes	Yes
Nursing	Yes	Yes
Homemaking/Housekeeping	No	Yes
Physical Therapy	Yes	Yes
Home Health Aide	Yes	Yes
Occupational Therapy	Yes	Yes
Personal Care Aide	No	Yes
Speech Therapy	Yes	Yes
Audiology	No	Yes
Respite Care	No	Yes
Meal Delivery	No	Yes

The table above shows the various services covered by both Medicare and Medicaid. We can see that Medicare’s primary focus is on skilled services, meaning services that require some form of certification/license from the individuals who will be administering care to patients.

AUTHORIZATION/REFERRALS/ORDERS

Under the various programs (Medicare and Medicaid), there are different steps you need to take before you begin servicing a client, these steps vary under the various types of insurance and programs in which the client has.

AUTHORIZATION

This sometimes might be termed “prior authorization”, meaning it’s the first documentation given to a provider by the clients’ insurance company to begin services. This document outlines the following:

·        Patient Name

·        Date of Birth

·        Insurance/Medicaid number

·        Authorization number

·        Diagnosis and Procedure codes

·        Requesting Provider

·        Servicing Provider

·        Service period

·        Service Status

·        Service units

The above are the main details you should look out for in an authorization.

Question: What kind of healthcare program gives out authorizations? What are the most important details in an authorization?

REFERRAL

When a hospital or rehab center discharges a patient to home health care, a document is usually sent to a home health agency alongside with the patient’s discharge papers. This document is also known as Referral. A referral is a document that is signed by a physician who is not necessary the patient’s primary care provider (PCP) sent to a home health agency for them to initiate services. A referral must contain the following information:

·        Name of facility

·        Date

·        Name of patient, address and date of birth

·        Patient’s insurance details

·        Order for home health

·        In some cases name of Agency providing home health

Question: Can referrals be used to commence services for a client that is under the care of an HMO? Please explain.

ORDERS

When patients go for routine checks with their doctor, he/she might decide the patient needs some form of home health service. In this scenario the doctor writes an order (like a prescription) to the home health agency explaining the kind of service that the patient needs at that time. In some cases, the doctor leaves the burden of assessment to the home health agency and no specific kind of treatment is ordered. The content of an order is the same with that of a referral; the only difference is that it is coming from a doctor’s clinic who is either the patient’s PCP or a specialist doctor.

Time-line for authorization and referrals: For Medicare patients, the golden rule is that a patient must be assessed and treated by the home health agency within 48hours of receipt of an order or referral from the doctor or hospital. In the case of HMOs or non-Medicare clients, the patient can be seen when authorization is received.

Question: In what scenario would an Agency be required to assess and treat a client without an authorization? What steps do you think the agency should take to avoid citation?

ELIGIBILITY

One thing you should take note: Authorization/Order/Referrals does not guarantee payment!

We already explained the criteria for eligibility for the various health programs within Medicare and Medicaid. But remember there are steps a client needs to take to be a member and remain eligible.

Question: What steps do you think a client who meets the Medicaid or and Medicare eligibility requirements, should take to be eligible for Home Health Care. What factors may cause a client to lose his/her eligibility?

MEDICARE

Medicare requires that an agency run an eligibility check on its members before service commences. Medicare has a 1-800 number in which providers can call in and check for a client’s status and what programs the client is eligible for. The following information is needed to check or verify a client’s eligibility:

·        Name and date of birth

·        Medicare Number

·        Sex

The provider/HHA would also be asked to verify the following information:

·        Tax ID

·        Medicare number

·        National Provider Identifier (NPI) number

Question: What are the benefits of an eligibility check to a HHA?

HMO

The process for eligibility check differs from members under the Medicare Part A plan. In most cases, authorization from the HMO means the patient is eligible for the services described in the authorization form sent to the agency. This is not usually the case. On the portal/website of each HMO, there is an area where eligibility checks on members can be viewed. A copy of this needs to be printed out filed for record purposes.

 SERVICE DELIVERY

Question: What are the main factors to be considered before skilled services be administered to a client?

At this stage the HHA as ascertained the following:

·  

•  HHA has an authorization/order/referral from a certified physician/HMO to commence services
•  Patient is eligible for Home Health service
• Agency is within network to provide services*

ANALYZING THE AUTHORIZATION/ORDER/REFERRAL

Step One: What service is required?

The HHA needs to be sure that the service required to be administered is covered under the contract with the HMO or Medicare

Step two: Does the agency have capacity?

If there order states “monthly blood draw” for 4 months, does the agency have an IV nurse to send to the patient’s home? Is the agency contracted with a lab to analyze the blood?

Step three: Is there a different procedure from Medicare as against HMOs?

United Healthcare still maintains almost the same procedure as per referrals although it has various programs in which it is handling now.

Step four: Are services ordered by the HMO/Physician need to contracted by the HHA to a third party?

If the authorization covers therapy services, the agency needs to ensure that it has reliable therapy company it is contracted who will administer care within the stipulated time frame. The therapy company also needs to have the required insurance needed to cover services for members under the Medicare plan or HMO plan as required.

  

PHYSICIAN APPROVAL

We mentioned earlier that a physician needs to continuously oversee the activities of the HHA agency as it affects the client/member. Some of the ways a physician can monitor these activities is through the following:

•  Plan of Care
• Communication/Progress notes
• Home Health Orders
•  Therapy Evaluations
• Discharge Summary/Re-certification
• 60 day summary

Note: Medicare requires all agencies servicing clients under the Part A program must obtain a document called “Face to Face” from the patient’s PCP within 30 days of servicing the client.